Adjuvant transarterial chemoembolization to sorafenib in unresectable hepatocellular carcinoma: A meta‐analysis

Abstract

Background and Aim An increasing number of transarterial chemoembolization (TACE) plus sorafenib combination therapy has been applied for unresectable hepatocellular carcinoma (HCC). However, it remains controversial whether combination therapy is superior to sorafenib monotherapy. Therefore, we aimed to perform a meta‐analysis to evaluate the efficacy and safety of the combination therapy of TACE plus sorafenib for unresectable HCC. Methods This meta‐analysis was based on the relative outcomes from a specific search of online databases between January 2008 and November 2019, and subgroup analyses were conducted to identify potential predictive factors. Results A total of 3868 patients (TACE plus sorafenib vs sorafenib, 1181 vs 2687) were identified from nine studies, including one randomized controlled trial and eight retrospective cohort studies. The pooled results revealed that TACE plus sorafenib combination therapy significantly improves overall survival with the combined hazard ratio 0.74 (95% confidence interval [CI] = 0.66–0.84, P < 0.001), time to progression (hazard ratio = 0.73, 95%CI = 0.65–0.82, P < 0.001), and objective response rate (odds ratio = 2.19, 95% CI = 1.31–3.66, P = 0.003). Subgroup analysis indicated that patients who developed macrovascular invasion achieve significantly great overall survival (P for interaction = 0.001) with combination therapy, in contrast to nonmacrovascular invasion patients. In addition, no significant differences in adverse events were observed. Conclusion This meta‐analysis demonstrated that TACE plus sorafenib combination therapy is superior to sorafenib monotherapy and should be recommended as an optimal treatment choice for unresectable HCC.

The Efficacy of TACE Combined With Lenvatinib Plus Sintilimab in Unresectable Hepatocellular Carcinoma: A Multicenter Retrospective Study

“…Therefore, many studies have adopted TACE combined with systemic therapy for the treatment of unresectable HCC ( 27 ). TACE combined with sorafenib and lenvatinib, respectively, are commonly used in unresectable HCC ( 6 , 28 – 30 ). The possible mechanism is that TACE induces angiogenesis and enhances the serum concentrations of VEGF because of local hypoxia, suggesting that VEGF may exert its greatest antiangiogenic effects before or after TACE ( 31 ).…”

Transarterial Chemoembolization Plus Sorafenib versus Transarterial Chemoembolization Alone for Advanced Hepatocellular Carcinoma: An Umbrella Review of Meta-Analyses and Systematic Reviews

“…These adverse events may lead to reduction and suspension of sorafenib therapy, which should be considered in clinical practice. However, in a meta-analysis by Chen et al, 55 the authors found no significant differences in adverse events between combination therapy and sorafenib monotherapy. In addition, some clinical trials have indicated that the safety and tolerance of TACE plus sorafenib are acceptable.…”

Comparative efficacy and safety of molecular targeted agents combined with transarterial chemoembolization in the treatment of unresectable hepatocellular carcinoma: a network meta-analysis

“…They thought that OS and time to progression (TTP) of combined treatment were significantly better than monotherapy. Chen et al (66) believed that compared to the monotherapy group, the combined treatment group showed a significant increase in OS, TTP, and ORR. Also, there was no statistically significant difference in the incidence of AEs between the two treatment groups.…”