Sorafenib combined with transarterial chemoembolization in patients with hepatocellular carcinoma: a meta-analysis and systematic review

Wang, Guiliang; Liu, Yan; Zhou, Shu‐Feng; Qiu, Ping; Xu, Liang; Wen, Ping; Wen, Jianbo; Xiao, Xianzhong

doi:10.1007/s12072-015-9700-7

Cited by 33 publications

(24 citation statements)

References 34 publications

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“…Several other studies have also reported that patients treated with combination therapy had longer survival duration [14-16]; however, survival outcomes in these studies, in which the study populations comprised partly or almost entirely BCLC stage B patients, were compared with those of TACE monotherapy. Although our study yielded results similar to those of the above-mentioned studies and included a larger number of patients receiving combination therapy, the current meta-analyses found that combination therapy only prolonged the time-to-progression but not overall survival [17, 18]. Therefore, further prospective randomized controlled trials are needed to confirm the clinical benefit of the combination therapy of TACE and sorafenib.…”

Section: Discussionsupporting

confidence: 62%

Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma

Lee

Shim

et al. 2016

Oncotarget

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BackgroundAlthough sorafenib is considered standard therapy for advanced hepatocellular carcinoma (HCC), actual treatments vary. We evaluated the effects of different treatment strategies on overall survival.MethodsA retrospective study of sorafenib-treated patients with advanced HCC was conducted. The primary outcome was overall survival. Prognostic factors were analyzed using multivariate Cox-proportional hazards model.ResultsA total of 658 patients (mean age, 54.5 years; 83.3% male) were analyzed; 293, 129, and 236 patients were treated with sorafenib, a combination therapy of sorafenib and transarterial chemoembolization (TACE), and TACE followed by sorafenib, respectively. Overall, 51.2% of patients treated under the combination strategy had portal vein invasion, whereas 89.9% of patients receiving sorafenib monotherapy had distant metastasis. Median overall survival durations were comparable (11.8 months for sorafenib, 16.2 months for the combination therapy, and 13.5 months for TACE followed by sorafenib; P = 0.13). However, among portal vein invasion cases, combination (25.7 months, P = 0.002) and TACE followed by sorafenib (14.0 months, P = 0.030) treatments were associated with longer overall survival duration compared with than sorafenib monotherapy (5.5 months). In a multivariate model, sorafenib duration (hazard ratio [HR], 0.96, P < 0.001) and TACE (HR, 0.24, P < 0.001) along with Child-Pugh stage (HR, 1.83, P = 0.005) were associated with better survival.ConclusionsIn patients with portal vein invasion, TACE performed concurrently with or before sorafenib administration is associated with better survival.

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Section: Discussionsupporting

confidence: 62%

Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma

Lee

Shim

et al. 2016

Oncotarget

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“…Three prior systematic reviews compared the effect of sorafenib plus TACE with TACE alone in patients with advanced HCC [17,20,21]. They all found that sorafenib combined with TACE significantly prolonged the time to progression, but did not significantly improve overall survival in patients with advanced HCC, which was inconsistent with our findings.…”

Section: Discussioncontrasting

confidence: 97%

“…However, the reviews differed with regard to the pooled overall survival and time to progression. Peng et al reported that sorafenib significantly improved the overall survival and time to progression(TTP) of advanced HCC [18], while Wang et al demonstrated that TTP was significant longer in the sorafenib plus TACE group than in the TACE alone group, but differences in overall survival between the two groups did not reach significance [21]. This systematic review aims to investigate the efficacy and safety of sorafenib in the management of unresectable HCC, and uses the GRADE system to evaluate the evidence value.…”

Section: Introductionmentioning

confidence: 99%

Sorafenib-based regimens in the management of unresectable hepatocellular carcinoma: an updated meta-analysis of randomized controlled trials

Yi¹,

Zhang²,

Xu³

et al. 2017

Dig Sys

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“…An analysis of the results from the GIDEON trial showed that TACE + SOR was a well-tolerated and viable therapeutic approach for the treatment of HCC 31. A meta-analysis showed that TACE + SOR improved TTP compared to TACE alone, but this analysis did not show any improvement in OS,32 while meta-analyses by Zhang et al21 and Hu et al9 showed that TACE + SOR improved both OS and TTP compared with TACE alone. This discrepancy could be due to a number of factors, including the studies being included and the populations being studied.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of TACE in combination with sorafenib for the treatment of TACE-refractory advanced hepatocellular carcinoma in Chinese patients: a retrospective study

Yang

et al. 2017

OTT

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BackgroundTransarterial chemoembolization (TACE) and sorafenib (SOR) are well-established treatments for hepatocellular carcinoma (HCC). This study evaluates the efficacy and safety of SOR combined with TACE in the treatment of patients with TACE-refractory, advanced-stage HCC.MethodsThis retrospective study included 61 patients with TACE-refractory advanced HCC. Patients were divided into TACE + SOR (n=30) and TACE (n=31) treatment groups. Patient demographic and clinical characteristics, overall survival (OS), time to progression (TTP), disease control rate (DCR), and adverse events (AEs) were compared between the two groups.ResultsCompared with TACE alone, the 5-year OS and TTP were prolonged in the TACE + SOR group (median OS: 17.9 vs 7.1 months, P<0.001; median TTP: 9.3 vs 3.4 months, P<0.001). Multivariate analysis showed that Child–Pugh class A (hazard ratio [HR], 0.234; 95% confidence interval [CI], 0.092–0.595), Eastern Cooperative Oncology Group performance status 1 (HR, 0.355; 95% CI, 0.153–0.826), alpha-fetoprotein <400 ng/mL (HR, 0.349; 95% CI, 0.177–0.689), and TACE + SOR treatment (HR, 0.151; 95% CI, 0.071–0.322) were independent, positive predictive factors of OS.ConclusionThe OS and TTP in the combined treatment group were significantly improved when compared with the TACE group. However, no significant difference in DCR was found between these two groups. While no AEs occurred in the TACE group, two patients in the TACE + SOR group experienced severe AEs which were effectively mitigated by lowering the dose of SOR. Thus, SOR in combination with TACE is a safe and effective treatment for advanced-stage, prior-TACE-resistant HCC.

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Sorafenib combined with transarterial chemoembolization in patients with hepatocellular carcinoma: a meta-analysis and systematic review

Abstract: In summary, our meta-analysis found that TACE + sorafenib can improve TTP. We did not find the combined therapy improved OS. Additional randomized controlled studies are necessary to further investigate the clinical benefit of TACE + sorafenib in treating advanced HCC.

Cited by 33 publications

References 34 publications

Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma

Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma

Sorafenib-based regimens in the management of unresectable hepatocellular carcinoma: an updated meta-analysis of randomized controlled trials

Efficacy and safety of TACE in combination with sorafenib for the treatment of TACE-refractory advanced hepatocellular carcinoma in Chinese patients: a retrospective study

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