181P Evaluation of first-line systemic treatments for unresectable hepatocellular carcinoma (uHCC): A network meta-analysis

Abstract

Background: Based on the phase III REFLECT study, lenvatinib (LEN) has been recommended as a first-line (1L) therapy for uHCC since 2018. Recent years have seen a further expansion of 1L treatment recommendations for uHCC, to include atezolizu-mab+bevacizumab, nivolumab, FOLFOX4 and donafenib. We conducted a network meta-analysis (NMA) to compare the efficacy and safety of lenvatinib with other systemic therapies in first-line uHCC. Methods: A systematic literature review identified randomized, controlled, multicenter trials in adults with advanced HCC who had received no prior systemic therapy. Literature retrieval was conducted using PubMed, ScienceDirect, the Cochrane Database, EMBASE and other sources. Objective response rate (ORR), disease progression-free survival (PFS), time-to-progression (TTP) and treatment discontinuations due to adverse events (AEs) were extracted from published studies and quantitatively pooled using frequentist NMA. Pairwise risk ratio(RR), hazard ratio(HR) with confidence interval was calculated. The P-scores were used to rank each treatment. Results: In total, 1398 records were screened and 27 were eligible for analysis, and the treatments included were atezolizumab+bevacizumab, brivanib, FOLFOX4, donafenib, dovitinib, lenvatinib, linifanib, nintedanib, nivolumab, sorafenib, sunitinib, vandetanib, 11 sorafenib combination therapies and three other combination therapies. For ORR and TTP, lenvatinib was ranked first (P-scores: 0.88 and 0.99), for PFS, atezolizumab+bevacizumab was ranked first followed by lenvatinib (