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  11. Evidence-based Management Of Hepatocellular Carcinoma: Systematic Review And Meta-analysis Of Randomized Controlled Trials (2002-2020)

Evidence-Based Management of Hepatocellular Carcinoma: Systematic Review and Meta-analysis of Randomized Controlled Trials (2002-2020)

Philipp K Haber1, Marc Puigvehí2, Florian Castet3

  • 1Mount Sinai Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Gastroenterology
|June 14, 2021

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View abstract on PubMed

Summary
This summary is machine-generated.

This study analyzed hepatocellular carcinoma (HCC) treatments, finding that immune checkpoint inhibitors (ICIs) show greater effectiveness in patients with viral hepatitis-related HCC compared to other etiologies.

Area of Science:

  • Hepatology
  • Oncology
  • Clinical Trials Research

Background:

  • Hepatocellular carcinoma (HCC) is a major cause of cancer mortality with evolving treatment options.
  • Numerous randomized controlled trials (RCTs) have been conducted over the past two decades to improve HCC patient outcomes.
  • Analyzing these trials is crucial for understanding treatment efficacy and influencing factors.

Purpose of the Study:

  • To systematically review phase III RCTs for HCC treatments from 2002-2020.
  • To conduct a meta-analysis examining the relationship between etiology and treatment outcomes.
  • To identify factors influencing patient response to systemic therapies like tyrosine-kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).

Main Methods:

  • Systematic review of phase III RCTs in HCC across all disease stages.
Keywords:
Hepatocellular carcinomaLiver cancerRandomized controlled trialsSystematic review

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  • Meta-analysis of 8 trials (3739 patients) comparing ICI and TKI/anti-VEGF therapies.
  • Inclusion of high-quality RCTs identified through a rigorous screening process.

    • Main Results:

    • 49 high-quality RCTs involving 22,113 patients were included.
    • Nine trials yielded positive results, leading to guideline adoption for six treatments.
    • Meta-analysis indicated ICI therapy was more effective in viral hepatitis-related HCC than nonviral etiologies; TKIs showed no etiological differences.

    Conclusions:

    • The study identified 9 positive RCTs out of 49 high-quality trials in HCC.
    • Systemic therapies, particularly immunotherapies, demonstrate differential efficacy based on etiology.
    • Immune checkpoint inhibitors show enhanced effectiveness in patients with viral hepatitis-related HCC.