Comparison of efficacy and safety of adjuvant therapies versus sorafenib in hepatocellular carcinoma: a systematic review and network meta-analysis

TL;DR

This study compares the effectiveness and safety of various treatments for liver cancer, finding that some combinations work better but cause more side effects.

Contribution

A systematic review and network meta-analysis comparing adjuvant therapies to sorafenib in hepatocellular carcinoma.

Findings

Combination therapies like OFL + sorafenib and sintilimab + bevacizumab biosimilar improved survival and response rates but caused more adverse effects.

Atezolizumab + bevacizumab and tepotinib showed favorable performance across all measured outcomes.

Combination therapies are effective but generally more toxic, highlighting the need for better strategies to reduce side effects.

Abstract

Diverse novel therapeutic options for hepatocellular carcinoma (HCC) have surfaced in recent years. However, it is increasingly difficult to select the optimal medication. This research aims to assess overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), adverse events (AEs), and severe adverse events (SAEs) in HCC patients receiving adjuvant therapies compared to those receiving sorafenib.

Four databases were used to search articles. Only randomized controlled trials were included. Indicators such as OS, PFS, DCR, ORR, AEs and SAEs were used as outcomes. The protocol for this meta-analysis was registered with PROSPERO (Registration ID: CRD42024544394).

Forty trials were included in this meta-analysis. The Oxaliplatin, Fluorouracil, and Leucovorin (OFL) + sorafenib group and the sintilimab + bevacizumab biosimilar group decreased the risk of death and increased PFS, ORR, and DCR. Yet, they also yielded remarkable adverse effects and severe adverse effects. To sum up, the atezolizumab + bevacizumab combination and tepotinib were recommended due to their favorable performance on all indexes.

This study further substantiates the efficacy of combination therapies in HCC, while they cause more toxicity in general. It is pressingly urgent to develop new drugs for liver cancer and find rational strategies to alleviate AEs.

PROSPERO, identifier CRD42024544394.

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