The efficacy and safety of Apatinib combined with TACE in the treatment of hepatocellular carcinoma: a meta-analysis

Abstract

Background The timely and effective treatments are vital to the prognosis of patients with hepatocellular carcinoma, and the role of Apatinib combined with TACE in the treatment of hepatocellular carcinoma remains unclear. Therefore, we aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of Apatinib combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma. Methods We searched for randomized controlled trials (RCTs) on Apatinib and TACE use in the treatment of hepatocellular carcinoma. Cochrane Central Register of Controlled Trials, Embase, PubMed, China Biomedical Literature Database, China Knowledge Network, Wanfang Database, and Weipu Chinese Science and Technology Journal Database were searched up to 16 April 2021. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis. This meta-analysis protocol had been registered online (available at: https://inplasy.com/inplasy-2021-6-0047/). Results A total of 14 RCTs involving 936 hepatocellular carcinoma patients were included. The objective remission rate (OR = 2.93, 95% CI 2.17–3.95), 1-year survival (OR = 2.47, 95% CI 1.65–3.68), 2-year survival (OR = 2.67, 95% CI 1.41–5.04), the incidence of hand-foot syndrome (OR = 32.09, 95% CI 10.87–94.74) and the incidence of proteinuria (OR = 14.79, 95% CI 6.07–36.06) of the Apatinib + TACE group was significantly higher than that of the TACE group (all P < 0.05). There were no significant differences in the incidence of myelosuppression (OR = 1.01, 95% CI 0.61–1.67), the incidence of hypertension (OR = 7.56, 95% CI 0.95–1.67, P = 60.17) between Apatinib + TACE and TACE group (all P > 0.05). Conclusions Apatinib combined with TACE is more effective than TACE alone in the treatment of hepatocellular carcinoma, but it has certain adverse reactions.

Transcatheter arterial chemoembolization plus apatinib with or without camrelizumab for unresectable hepatocellular carcinoma: a multicenter retrospective cohort study

“…The inclusion criteria were: (1) Patients with primary non-diffuse unresectable HCC who were Barcelona Clinic Liver Cancer (BCLC) stage B/C, or those who showed recurrence following surgery; (2) Clinically or pathologically confirmed unresectable HCC with at least one measurable lesion according to the modified version of the Response Evaluation Criteria for Solid Tumors (mRECIST); (3) No systemic chemotherapy, targeted therapy other than apatinib (such as sorafenib, regorafenib), or immunotherapy other than camrelizumab (including PD-1/PD-L1/CTLA-4 inhibitors) was used; (4) aged 18-80 years old; (5) Eastern Cooperative Oncology Group Performance Status score (ECOG PS) of 0-1 within one week before treatment; (6) Less than 60% of the liver volume was occupied by tumors; (7) There are no serious comorbidities, such as hypertension, coronary heart disease, psychiatric history, or serious allergies; (8) Patients with Child-Pugh A or B (score 7), normal renal function, and normal coagulation function or be corrected after treatment; (9) Have received as least one cycle of systemic treatment (one dose of camrelizumab plus three weeks of apatinib for TACE + AC group, and three weeks of apatinib for TACE + A group). Patients received other treatment such as microwave ablation or radiofrequency ablation or changed targeted regimen before disease progression were excluded.…”

“…It is noteworthy that 27.5% of patients in the 750 mg cohort and 40% in the 850 mg cohort had previously undergone locoregional therapies [ 6 ]. Furthermore, a meta-analysis involving 14 randomized controlled trials has demonstrated that apatinib plus TACE is more effective than TACE alone for patients with unresectable HCC [ 7 ].…”

The long-term efficacy and safety of apatinib are inferior to sorafenib in the first-line treatment of advanced hepatocellular carcinoma: A systematic review and meta-analysis

“…Many studies have shown that TACE combined with sorafenib can significantly prolong PFS in patients with advanced HCC, [6,7] and TACE combined with apatinib can significantly improve the survival outcome of HCC patients compared with TACE alone. [35] In the setting of combined TACE treatment, apatinib and sorafenib can benefit patients with advanced HCC, but their efficacy and safety are still controversial in clinical studies directly comparing apatinib plus TACE and sorafenib plus TACE. [10,11] Based on this, we conducted a comprehensive literature search (up to August 14, 2023) to evaluate the efficacy and safety of a new TKI (apatinib) versus a traditional TKI (sorafenib) in the first-line treatment of advanced HCC, including evaluating the differences in efficacy and safety of these 2 TKIs in the setting of combined TACE treatment, so as to provide evidence for clinical rational drug use.…”

Efficacy and safety of TACE combined with tyrosine kinase inhibitors and camrelizumab for unresectable hepatocellular carcinoma: A systematic review and meta‑analysis

“…Although a relevant study has shown that T-T combination therapy has a positive effect on patients with advanced HCC ( 55 ), it is still weaker than triple therapy with T-T-C. The reasons can be summarized as follows: TACE can cause local necrosis of tumors, cause tumor tissues to release antigens, trigger anticancer immune responses, increase the expression of PD-1 and improve tumor recognition ability.…”