Cargando…
Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis
BACKGROUND: Hepatocellular carcinoma (HCC) is one of the cancers with the highest morbidity and mortality. Sorafenib used to be the main treatment for unresectable HCC patients. However, regimens based on immune checkpoint inhibitors (ICIs) have attracted attention in recent years because of their r...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9519826/ https://www.ncbi.nlm.nih.gov/pubmed/36171533 http://dx.doi.org/10.1007/s12672-022-00559-1 |
_version_ | 1784799485017194496 |
---|---|
author | Lei, Qing Yan, Xin Zou, Huimin Jiang, Yixuan Lai, Yunfeng Ung, Carolina Oi Lam Hu, Hao |
author_facet | Lei, Qing Yan, Xin Zou, Huimin Jiang, Yixuan Lai, Yunfeng Ung, Carolina Oi Lam Hu, Hao |
author_sort | Lei, Qing |
collection | PubMed |
description | BACKGROUND: Hepatocellular carcinoma (HCC) is one of the cancers with the highest morbidity and mortality. Sorafenib used to be the main treatment for unresectable HCC patients. However, regimens based on immune checkpoint inhibitors (ICIs) have attracted attention in recent years because of their reported benefits. This study aimed to evaluate the efficacy and safety of monotherapy and combination therapy of ICIs as first-line treatment for unresectable HCC patients by conducting a systematic review, meta-analysis, and network meta-analysis. METHODS: Studies published up to 11st August 2022 were searched from 4 commonly used databases, including PubMed, Web of Science, Embase, and Clinical trials.gov. All eligible clinical trials were included. Data about reported objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs) were extracted. RESULTS: Of the 8579 studies retrieved, 24 met the inclusion criteria. In patients with unresectable HCC taking ICIs-based therapy as first-line treatment, the pooled result of median PFS and median OS was 5.76 months (95% CI 4.82–6.69) and 16.35 months (95% CI 15.19–17.51) The ORR and DCR were 25.1% (95% CI 20.8–29.5%) and 75.2% (95% CI 70.3–80.2%) measured by RECIST v1.1 or 40.2% (95% CI 31.7–48.6%) with 75.2% (95% CI 68.3–82.1%) measured by mRECIST v1.1. Compared to sorafenib, ICIs-based therapy significantly prolonged OS. The combination treatment of sintilimab plus IBI305 had the highest ORR, while atezolizumab plus bevacizumab had the highest DCR. The pooled incidence of any grade TRAEs was 82.3% (95% CI 73.9–90.7%), with highest incidence appeared in dysphonia. CONCLUSIONS: This study demonstrated that first-line ICIs-based therapies could provide survival benefits for patients with unresectable HCC, with manageable TRAEs. The potential of combination treatment to become the new treatment trend in clinical practice is promising. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12672-022-00559-1. |
format | Online Article Text |
id | pubmed-9519826 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-95198262022-09-30 Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis Lei, Qing Yan, Xin Zou, Huimin Jiang, Yixuan Lai, Yunfeng Ung, Carolina Oi Lam Hu, Hao Discov Oncol Review BACKGROUND: Hepatocellular carcinoma (HCC) is one of the cancers with the highest morbidity and mortality. Sorafenib used to be the main treatment for unresectable HCC patients. However, regimens based on immune checkpoint inhibitors (ICIs) have attracted attention in recent years because of their reported benefits. This study aimed to evaluate the efficacy and safety of monotherapy and combination therapy of ICIs as first-line treatment for unresectable HCC patients by conducting a systematic review, meta-analysis, and network meta-analysis. METHODS: Studies published up to 11st August 2022 were searched from 4 commonly used databases, including PubMed, Web of Science, Embase, and Clinical trials.gov. All eligible clinical trials were included. Data about reported objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs) were extracted. RESULTS: Of the 8579 studies retrieved, 24 met the inclusion criteria. In patients with unresectable HCC taking ICIs-based therapy as first-line treatment, the pooled result of median PFS and median OS was 5.76 months (95% CI 4.82–6.69) and 16.35 months (95% CI 15.19–17.51) The ORR and DCR were 25.1% (95% CI 20.8–29.5%) and 75.2% (95% CI 70.3–80.2%) measured by RECIST v1.1 or 40.2% (95% CI 31.7–48.6%) with 75.2% (95% CI 68.3–82.1%) measured by mRECIST v1.1. Compared to sorafenib, ICIs-based therapy significantly prolonged OS. The combination treatment of sintilimab plus IBI305 had the highest ORR, while atezolizumab plus bevacizumab had the highest DCR. The pooled incidence of any grade TRAEs was 82.3% (95% CI 73.9–90.7%), with highest incidence appeared in dysphonia. CONCLUSIONS: This study demonstrated that first-line ICIs-based therapies could provide survival benefits for patients with unresectable HCC, with manageable TRAEs. The potential of combination treatment to become the new treatment trend in clinical practice is promising. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12672-022-00559-1. Springer US 2022-09-28 /pmc/articles/PMC9519826/ /pubmed/36171533 http://dx.doi.org/10.1007/s12672-022-00559-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Review Lei, Qing Yan, Xin Zou, Huimin Jiang, Yixuan Lai, Yunfeng Ung, Carolina Oi Lam Hu, Hao Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
title | Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
title_full | Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
title_fullStr | Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
title_full_unstemmed | Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
title_short | Efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
title_sort | efficacy and safety of monotherapy and combination therapy of immune checkpoint inhibitors as first-line treatment for unresectable hepatocellular carcinoma: a systematic review, meta-analysis and network meta-analysis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9519826/ https://www.ncbi.nlm.nih.gov/pubmed/36171533 http://dx.doi.org/10.1007/s12672-022-00559-1 |
work_keys_str_mv | AT leiqing efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis AT yanxin efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis AT zouhuimin efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis AT jiangyixuan efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis AT laiyunfeng efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis AT ungcarolinaoilam efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis AT huhao efficacyandsafetyofmonotherapyandcombinationtherapyofimmunecheckpointinhibitorsasfirstlinetreatmentforunresectablehepatocellularcarcinomaasystematicreviewmetaanalysisandnetworkmetaanalysis |