Efficacy and safety of immune checkpoint inhibitors combined anti-angiogenic therapy in patients with unresectable hepatocellular carcinoma: A meta-analysis

This study aimed to compare the efficacy and safety of immune checkpoint inhibitors (ICIs) combined with antiangiogenic agents in patients with unresectable hepatocellular carcinoma (HCC). METHODS: We conducted a systematic literature search of articles published between the establishment of the database and February 2022. Data were extracted and analyzed using STATA 14.0. RESULTS: Six randomized controlled trials (RCTs) (980 patients for combination therapy and 565 patients for monotherapy) and 5 single-arm studies (246 patients for ICIs combination therapy) were enrolled. The objective response rate (ORR) and disease control rate (DCR) were 26% and 70%, respectively, after ICIs combination therapy. Compared with monotherapy in RCTs, ICIs combination therapy resulted in higher progression-free survival (PFS) and overall survival (OS), but also increased the incidence of adverse events (AEs). Increased incidences of fatigue, hypertension, hyperbilirubinemia, proteinuria, and nausea were more common after ICIs combination therapy. CONCLUSION: The analysis results reveal that ICI-combined anti-angiogenesis therapy has higher efficacy than either ICIs or anti-angiogenesis options for unresectable HCC, but it is necessary to manage the AEs.