Efficacy and Safety of Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: A Systematic Review and
Muhammad A B Naeem1, Muhammad R Paracha1, Ahmad Noor1
1Department of Medicine, Allama Iqbal Medical College.
Objectives:
Previous meta-analyses have assessed the benefits and safety profile of immune checkpoint inhibitors in hepatocellular carcinoma patients. This meta-analysis provides an updated synthesis by incorporating the newly published studies and previous studies with the revised data.
Methods:
A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases (PubMed, Google Scholar, and Cochrane Library) were searched for randomized controlled trials (RCTs) comparing Immune Checkpoint Inhibitors to Standard Therapy or Placebo in patients with Hepatocellular Carcinoma. Studies were selected based on predefined eligibility criteria, and odds ratios (ORs) and hazard ratios (HRs) for outcomes were calculated using a random effects model.
Results:
Eighteen RCTs involving 9244 patients were included in this study. Compared with the control group, ICIs were associated with a significantly improved objective response rate (ORR) (OR=3.20, 95% CI: 2.44-4.20, P =<0.00001), disease control rate (DCR) (OR=1.40, 95% CI: 1.08-1.81, P =0.01), stable disease (SD) (OR=2.15, 95% CI: 1.16-3.98, P =0.02), overall survival (OS) (HR=0.79, 95% CI: 0.73-0.86, P =<0.00001), progression-free survival (PFS) (HR=0.77, 95% CI: 0.69-0.87, P =<0.00001) and all-cause grade ≥3 adverse events (OR=1.36, 95% CI: 1.10-1.67, P =0.005). No significant differences were observed between the 2 groups in terms of progressive disease (PD) (OR=0.88, 95% CI: 0.67-1.15, P =0.34), all-cause any-grade adverse events (OR=1.04, 95% CI: 0.51-2.11, P =0.91), treatment-related any-grade adverse events (OR=1.32, 95% CI: 0.67-2.59, P =0.42), and treatment-related grade ≥3 adverse events (OR=1.16, 95% CI: 0.65-2.09, P =0.61).
Conclusions:
By incorporating the most recent data and the newly published studies, this updated meta-analysis offers a clearer understanding of immune checkpoint inhibitors and reinforces their advantage over other therapeutic options in the treatment of hepatocellular carcinoma. Continued research is encouraged that will further validate these findings.
