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First-line systemic treatment for hepatocellular carcinoma: A systematic review and network meta-analysis

Domenico Ciliberto1, Giulio Caridà2, Nicoletta Staropoli1,2

  • 1Renato Dulbecco Hospital, Catanzaro, Italy.

Heliyon
|August 10, 2023
PubMed

Insights

For advanced hepatocellular carcinoma (aHCC), Camrelizumab plus Rivoceranib combination therapy shows the best overall survival. Durvalumab is the most tolerated treatment option for patients.

Area of Science:

  • Hepatobiliary Cancers
  • Medical Oncology
  • Clinical Trials

Background:

  • Advanced hepatocellular carcinoma (aHCC) presents treatment selection challenges due to novel therapeutic options.
  • Immune checkpoint inhibitors (ICIs) combined with anti-VEGF agents are key strategies for aHCC.

Purpose of the Study:

  • To compare the efficacy and toxicity of various systemic upfront treatments for aHCC.
  • To identify the optimal first-line therapy for advanced hepatocellular carcinoma.

Main Methods:

  • Systematic review and meta-analysis of randomized clinical trials.
  • Evaluation of overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and tolerability.
  • Treatment ranking using Surface Under the Cumulative Rankings (SUCRA).

Main Results:

  • Camrelizumab + Rivoceranib combination demonstrated the highest probability for best OS.
  • Lenvatinib + Pembrolizumab showed the highest probability for best PFS.
  • Sintilimab + Bevacizumab combination achieved the best ORR.
  • Durvalumab was identified as the most tolerated treatment option.

Conclusions:

  • The choice of first-line therapy for aHCC depends on the desired outcome, balancing efficacy (OS, PFS, ORR) and tolerability.
  • Combination therapies like Camrelizumab + Rivoceranib and Sintilimab + Bevacizumab show promise for improving survival and response rates.
  • Durvalumab offers a favorable tolerability profile for aHCC management.
Keywords:
Advanced hepatocellular carcinomaAtezolizumabDurvalumabFirst lineHCCICILenvatinibSorafenibTKITremelimumab

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