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      Comparative efficacy and safety of multimodality treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: patient-level network meta-analysis

      systematic-review

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          Abstract

          Background

          Portal vein tumor thrombus (PVTT) is a common complication and an obstacle to treatment, with a high recurrence rate and poor prognosis. There is still no global consensus or standard guidelines on the management of hepatocellular carcinoma (HCC) with PVTT. Increasing evidence suggests that more aggressive treatment modalities, including transarterial chemoembolization, radiotherapy, targeted therapy, and various combination therapies, may improve the prognosis and prolong the survival of advanced hepatocellular carcinoma (aHCC) patients with PVTT. We aim to comprehensively review and compare the efficacy and safety of these advanced options for aHCC with PVTT.

          Methods

          A comprehensive literature search was conducted on PubMed and EMBASE for phase II or III randomized controlled trials (RCTs) investigating multimodality treatments for aHCC with PVTT. Kaplan–Meier curves for overall survival (OS) and progression-free survival were constructed to retrieve individual patient-level data to strengthen the comparison of the benefits of all multimodality treatments of interest. Each study was pooled in a fixed-effects network meta-analysis (NMA). We also conducted subgroup analyses using risk ratios extracted from each study, including viral etiology, Barcelona Clinic Liver Cancer (BCLC) staging, alpha-fetoprotein (AFP) levels, macrovascular invasion or portal vein tumor thrombosis, and extrahepatic spread. Multimodality treatments were ranked using SUCRA scores.

          Results

          We identified 15 randomized controlled trials with 16 multimodality regimens that met the inclusion criteria. Among them, 5,236 patients with OS results and 5,160 patients with PFS results were included in the analysis. The hepatic arterial infusion chemotherapy of fluorouracil, leucovorin, and oxaliplatin (HAIC-FO) showed OS and PFS benefits over all the other therapies. In terms of OS, HAIC-FO, nivolumab, and TACE+Len were superior to sorafenib, lenvatinib, and donatinib monotherapies, as well as HAIC-FO+Sor. In terms of PFS, TACE+Len showed better benefits than lenvatinib, donatinib, and tremelimumab+durvalumab. A low heterogeneity ( I 2 < 50%) and consistency were observed. The SUCRA score for OS ranked HAIC-FO+sorafenib as the best treatment option among all multimodality treatments in hepatitis B, MVI, or PVTT with EHS and AFP 400 μg/L subgroups.

          Conclusion

          HAIC-FO and HAIC-FO+sorafenib are statistically better options for unresectable hepatocellular carcinoma with PVTT among the multimodality treatments, and their effective and safe implementation may provide the best outcomes for HCC-PVTT patients.

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          Most cited references56

          • Record: found
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          Measuring inconsistency in meta-analyses.

          Julian P T Higgins, Simon G Thompson, Jonathan J Deeks … (2003)
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            Sorafenib in advanced hepatocellular carcinoma.

            Josep Llovet, Sergio Ricci, Vincenzo Mazzaferro … (2008)
            No effective systemic therapy exists for patients with advanced hepatocellular carcinoma. A preliminary study suggested that sorafenib, an oral multikinase inhibitor of the vascular endothelial growth factor receptor, the platelet-derived growth factor receptor, and Raf may be effective in hepatocellular carcinoma. In this multicenter, phase 3, double-blind, placebo-controlled trial, we randomly assigned 602 patients with advanced hepatocellular carcinoma who had not received previous systemic treatment to receive either sorafenib (at a dose of 400 mg twice daily) or placebo. Primary outcomes were overall survival and the time to symptomatic progression. Secondary outcomes included the time to radiologic progression and safety. At the second planned interim analysis, 321 deaths had occurred, and the study was stopped. Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; 95% confidence interval, 0.55 to 0.87; P<0.001). There was no significant difference between the two groups in the median time to symptomatic progression (4.1 months vs. 4.9 months, respectively, P=0.77). The median time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo group (P<0.001). Seven patients in the sorafenib group (2%) and two patients in the placebo group (1%) had a partial response; no patients had a complete response. Diarrhea, weight loss, hand-foot skin reaction, and hypophosphatemia were more frequent in the sorafenib group. In patients with advanced hepatocellular carcinoma, median survival and the time to radiologic progression were nearly 3 months longer for patients treated with sorafenib than for those given placebo. (ClinicalTrials.gov number, NCT00105443.) 2008 Massachusetts Medical Society
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              Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial

              Min Ren, Silvija Kraljevic, Kenichi Saito … (2018)
              In a phase 2 trial, lenvatinib, an inhibitor of VEGF receptors 1-3, FGF receptors 1-4, PDGF receptor α, RET, and KIT, showed activity in hepatocellular carcinoma. We aimed to compare overall survival in patients treated with lenvatinib versus sorafenib as a first-line treatment for unresectable hepatocellular carcinoma.
              Article 0 comments Cited 2045 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                John Hang Leung: Role: Role:
                Shyh-Yau Wang: Role:
                Henry W. C. Leung: Role: Role:
                Agnes L. F. Chan: URI : https://loop.frontiersin.org/people/2258418Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Oncol
                Journal ID (iso-abbrev): Front Oncol
                Journal ID (publisher-id): Front. Oncol.
                Title: Frontiers in Oncology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2234-943X
                Publication date (Electronic): 16 February 2024
                Publication date Collection: 2024
                Volume: 14
                Electronic Location Identifier: 1344798
                Affiliations
                [1] 1 Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi, Taiwan
                [2] 2 Department of Radiology, An-Nan Hospital, China Medical University , Tainan, Taiwan
                [3] 3 Department of Radiation Oncology, An-Nan Hospital, China Medical University , Tainan, Taiwan
                [4] 4 Department of Pharmacy, An-Nan Hospital, China Medical University , Tainan, Taiwan
                Author notes

                Edited by: Francisco Tustumi, University of São Paulo, Brazil

                Reviewed by: Jiqiao Zhu, Capital Medical University, China

                Abdullah Esmail, Houston Methodist Hospital, United States

                Phillipe Abreu, Jackson Health System, United States

                *Correspondence: Henry W. C. Leung, 070506@ 123456tool.caaumed.org.tw ; Agnes L. F. Chan, agnes.lf@ 123456gmail.com

                †These authors share first authorship

                Article
                DOI: 10.3389/fonc.2024.1344798
                PMC ID: 10905023
                PubMed ID: 38434681
                SO-VID: 11c168f4-24e0-4e45-9fc9-dcfbb7bce54f
                Copyright © Copyright © 2024 Leung, Wang, Leung and Chan
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 26 November 2023
                Date accepted : 16 January 2024
                Page count
                Figures: 5, Tables: 3, Equations: 0, References: 57, Pages: 16, Words: 7683
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by TAINAN MUNICIPAL AN-NAN HOSPITAL-CHINA MEDICAL UNIVERSITY ANHRF 111-33.
                Categories
                Subject: Oncology
                Subject: Systematic Review
                Custom metadata
                section-in-acceptance Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: patient-level nma,multimodality treatments,hepatic arterial infusion chemotherapy,advanced or metastatic hepatocellular carcinoma,portal vein tumor thrombosis
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: patient-level nma, multimodality treatments, hepatic arterial infusion chemotherapy, advanced or metastatic hepatocellular carcinoma, portal vein tumor thrombosis

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