VEGF Inhibitors Improve Survival Outcomes in Patients with Liver Metastases across Cancer Types—A Meta-Analysis

SIMPLE SUMMARY: The liver is a common site of metastasis across multiple solid organ malignancies. Liver metastases are a known site of treatment resistance, regardless of the site of primary tumour, and their presence is associated with a poor prognosis. This meta-analysis of 4445 patients from 25 randomized controlled trials demonstrated that the addition of vascular endothelial growth factor inhibitors to standard of care improved survival in patients with liver metastases across cancer types. This study highlights the efficacy of vascular endothelial growth factor inhibitors in liver metastases and suggests a treatment approach for clinicians with a focus on sites of metastasis rather than the established primary-specific approach. ABSTRACT: Background: Liver metastases are associated with poor prognosis across cancers. Novel treatment strategies to treat patients with liver metastases are needed. This meta-analysis aimed to assess the efficacy of vascular endothelial growth factor inhibitors in patients with liver metastases across cancers. Methods: A systematic search of PubMed, Cochrane CENTRAL, and Embase was performed between January 2000 and April 2023. Randomized controlled trials of patients with liver metastases comparing standard of care (systemic therapy or best supportive care) with or without vascular endothelial growth factor inhibitors were included in the study. Outcomes reported included progression-free survival and overall survival. Results: A total of 4445 patients with liver metastases from 25 randomized controlled trials were included in this analysis. The addition of vascular endothelial growth factor inhibitors to standard systemic therapy or best supportive care was associated with superior progression-free survival (HR = 0.49; 95% CI, 0.40–0.61) and overall survival (HR = 0.83; 95% CI, 0.74–0.93) in patients with liver metastases. In a subgroup analysis of patients with versus patients without liver metastases, the benefit with vascular endothelial growth factor inhibitors was more pronounced in the group with liver metastases (HR = 0.44) versus without (HR = 0.57) for progression-free survival, but not for overall survival. Conclusion: The addition of vascular endothelial growth factor inhibitors to standard management improved survival outcomes in patients with liver metastasis across cancers.