Transcatheter hepatic arterial infusion chemotherapy vs sorafenib in the treatment of patients with hepatocellular carcinoma of Barcelona Clinic Liver Cancer stage C: a meta-analysis of Asian population

Abstract

ObjectiveTo compare the clinical efficacy and safety of transcatheter hepatic arterial infusion chemotherapy (HAIC) with those of sorafenib in the treatment of patients with hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage C.MethodsPotentially relevant studies comparing the clinical efficacy and safety of HAIC with those of sorafenib were searched using Medline, PubMed, Embase, Cochrane Library, and Chinese databases (Wanfang Data and China National Knowledge Infrastructure). Overall survival rate (OSR), tumor response rate, disease control rate (DCR), and serious adverse events (SAEs) were compared and analyzed. Pooled ORs with 95% CIs were calculated using either the fixed-effects model or the random-effects model. All statistical analyses were conducted using Review Manager (version 5.3) from the Cochrane Collaboration.ResultsA total of 1,264 patients were included in this meta-analysis. The results of this study showed that HAIC was associated with significantly higher 1-, 2-, and 3-year OSRs than sorafenib (OR 1.88, 95% CI1-year: [1.27–2.78], P1-year=0.002; OR 2.15, 95% CI2-year: [1.06–4.37], P2-year=0.03; OR 7.90, 95% CI3-year: [2.12–29.42], P3-year=0.002). Compared to sorafenib, HAIC was associated with superior complete response (CR), partial response (PR), and objective response rate (ORR) (OR 3.90, 95% CICR: [1.89–8.03], PCR =0.0002; OR 3.47, 95% CIPR: [2.31–5.24], PPR <0.00001; OR 3.02, 95% CIOR: [2.05–4.45], POR <0.0001). There was no statistically significant difference between HAIC and sorafenib in stable disease (SD), progressive disease (PD), DCR, and SAEs (OR 0.86, 95% CISD: [0.51–1.45], PSD =0.56; OR 0.62, 95% CIPD: [0.35–1.11], PPD =0.11; OR 0.53, 95% CISAE: [0.14–1.92], PSAE =0.33).ConclusionThis study showed that HAIC was associated with better efficacy than sorafenib in terms of OSR and tumor response. Therefore, HAIC can be considered as an alternative treatment option for patients with HCCs of BCLC stage C.

Sorafenib is more effective in the treatment of TACE-refractory hepatocellular carcinoma than hepatic arterial infusion chemotherapy: a meta-analysis

“…Through systematic literature retrieval, a total of 5 articles were included in this study. Different from the conclusion of previous systematic reviews [27][28][29], the study showed that sorafenib could prolong the overall survival of patients with TACE-refractory HCC compared with HAIC (HR = 1.69, 95% CI [1.09, 2.62], p=0.018). Although the ORR of the HAIC group was significantly higher than that of the sorafenib group (RR = 3.08, 95%CI [1.38, 6.87], p=0.006), the DCR between the HAIC group and the sorafenib group was not significantly different (RR = 0.94, 95%CI [0.60, 1.48], p=0.798).…”

“…Compared with sorafenib, HAIC shows a better therapeutic effect and a lower incidence of adverse events (AEs) in the treatment of advanced or unresectable HCC [27][28][29]. HAIC has been widely used in Japan [12].…”

Hepatic arterial infusion chemotherapy versus Sorafenib for advanced hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

“…Zhuang BW et al [24] which conducted a meta-analysis about the safety and benefits of sorafenib versus HAIC for advanced HCC, found that HAIC found that HAIC was more effective and safe than sorafenib and recommend HAIC as an alternative treatment for advanced HCC. Another meta-analysis implemented by Ni JY et al [39], compared the HAIC versus sorafenib for HCC patients with BCLC stage C; they also reported that HAIC achieved better tumor response and clinical efficacy and recommend HAIC for patients with HCC of BCLC stage C. The two previous studies were all compared HAIC with sorafenib for advanced patients(BCLC stage C). BCLC stage C was mean with vascular invasion, extrahepatic spread, Child-Pugh A or B, Performance status (PS) 1 or 2 and was defined as advanced stage disease [1].…”

Underlying mechanism of sorafenib resistance in hepatocellular carcinoma: a bioinformatics study based on validated resistance-related genes

“…However, the effects of sorafenib can be compromised (1)(2)(3)(4); it has been shown to significantly extend the median survival time of treated patients, but only by 3-5 months. This has largely been attributed to the development of resistance within 6 months (3)(4)(5)(6). Combination of sorafenib and cytotoxic chemotherapeutic agents, or molecular targeted agents, or immunotherapeutic drugs were studied to overcome sorafenib resistance in HCC (7).…”