Transarterial chemoembolization combined with lenvatinib versus transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: A systematic review and meta-analysis

Abstract

BackgroundThe combination of tyrosine kinase inhibitors (TKIs) and transarterial chemoembolization (TACE) fulfills an important role in the treatment of unresectable hepatocellular carcinoma (uHCC). Among the combination therapies, both lenvatinib and sorafenib combined with TACE are recommended as first-¬line treatments for uHCC. However, at present, limited data are available concerning the efficacy and safety of these two combination therapies in uHCC.MethodsA detailed systematic search for studies on lenvatinib plus TACE (LEN+TACE) and sorafenib plus TACE (SOR+TACE) was conducted in the online databases PubMed, Embase and The Cochrane Library. The outcome data including overall survival (OS), progression free survival (PFS), time to progression (TTP), tumor response and adverse events (AEs), were independently extracted by two authors in a standardized way.ResultsOne randomized controlled trial and five cohort studies with 598 patients (LEN+TACE: 261, SOR+TACE: 337) were included in the meta-analysis. A higher rate of odds ratio (OR) for the objective response rate (ORR) [OR: 3.63; 95% confidence intervals (95% CI): 1.89-6.95; I squared statistic (I2) = 57%, P < 0.001] and disease control rate (DCR) (OR: 3.78; 95% CI: 2.00-7.16; I2 = 52%, P = 0.0001) were observed in the LEN+SOR group compared with the SOR+TACE group. The LEN+TACE group also had significant longer OS [hazard ratio (HR): 0.67; 95% CI: 0.52-0.85; I2 = 1%, P = 0.001], PFS (HR: 0.49; 95% CI: 0.38-0.62; I2 = 0%, P? 0.001) and TTP (HR: 0.62; 95% CI: 0.45-0.84; I2 = 0%, P = 0.002) compared with the SOR+TACE group. The incidence of hypertension (OR: 3.05; 95% CI: 1.45-6.39; P = 0.003) and proteinuria (OR: 5.25; 95% CI: 1.73-15.89; P = 0.003) were significantly higher in the LEN+TACE group than SOR+TACE group, while LEN+TACE group exhibited a lower rate of hand–foot–skin reaction (HFSR) (OR: 0.51; 95% CI: 0.27-0.95; P = 0.03) compared with the SOR+TACE group.ConclusionThe combination therapy of LEN+TACE showed significant superiority compared with SOR+TACE in terms of its efficacy for patients with uHCC. SOR+TACE should be recommended as a replacement therapy when serious AEs occur during the administration of LEN+TACE as the combination therapy.

Lenvatinib in combination with transarterial chemoembolization vs. sorafenib in combination with transarterial chemoembolization for unresectable hepatocellular carcinoma: A network meta‑analysis

“…Sorafenib showed a higher rate of HFSR (11 vs. 3%) and a lower rate of hypertension (14 vs. 23%) than lenvatinib. In our previous meta-analysis, there were significant differences regarding HFSR (HR, 0.51, 95%; CI, 0.27-0.95) and hypertension (HR, 3.05; 95% CI, 1.45-6.39) between the two combination therapy groups, and the differences in incidence of HFSR and hypertension were similar to results of the REFLECT trial (12,15). However, the present NMA found no significant difference regarding HFSR and hypertension between the two combination therapy groups.…”

Influence of transcatheter arterial embolization on symptom distress and fatigue in liver cancer patients

“…This may also contribute to a more pronounced post-treatment fatigue, as patients may experience the biological effects of the drug over an extended period. When used in conjunction with gel, it effectively inhibits the development of new tumor blood vessels, achieving therapeutic efficacy[ 23 , 24 ]. Consequently, patients with larger tumor diameters may receive higher embolization doses, leading to transient liver and gallbladder ischemia, hepatomegaly, and peritoneal stimulation-induced pain.…”

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

“…Liu et al. ( 70 ) conducted a meta-analysis comparing Lenv+TACE with Sora+TACE and found that the OS and PFS of the Lenv+TACE group were significantly better than those of Sora+TACE. In terms of safety, the incidence of hypertension and proteinuria was significantly higher in the Lenv+TACE group than in the Sora+TACE group, while the opposite was true for the hand-foot syndrome.…”