VEGF Inhibitors Improve Survival Outcomes in Patients with Liver Metastases across Cancer Types—A Meta-Analysis

Abstract

Background: Liver metastases are associated with poor prognosis across cancers. Novel treatment strategies to treat patients with liver metastases are needed. This meta-analysis aimed to assess the efficacy of vascular endothelial growth factor inhibitors in patients with liver metastases across cancers. Methods: A systematic search of PubMed, Cochrane CENTRAL, and Embase was performed between January 2000 and April 2023. Randomized controlled trials of patients with liver metastases comparing standard of care (systemic therapy or best supportive care) with or without vascular endothelial growth factor inhibitors were included in the study. Outcomes reported included progression-free survival and overall survival. Results: A total of 4445 patients with liver metastases from 25 randomized controlled trials were included in this analysis. The addition of vascular endothelial growth factor inhibitors to standard systemic therapy or best supportive care was associated with superior progression-free survival (HR = 0.49; 95% CI, 0.40–0.61) and overall survival (HR = 0.83; 95% CI, 0.74–0.93) in patients with liver metastases. In a subgroup analysis of patients with versus patients without liver metastases, the benefit with vascular endothelial growth factor inhibitors was more pronounced in the group with liver metastases (HR = 0.44) versus without (HR = 0.57) for progression-free survival, but not for overall survival. Conclusion: The addition of vascular endothelial growth factor inhibitors to standard management improved survival outcomes in patients with liver metastasis across cancers.

Trifluridine/tipiracil with and without ramucirumab for advanced gastric cancer: a comparative observational study

“…Preclinical data showed an association between anti-VEGF discontinuation and enhanced liver metastasis, indicating a strong correlation between VEGF and liver metastasis 27 . The mechanism by which VEGF inhibitors are effective against LM remains unclear; however, the unique tumor microenvironment in LM may enhance the effectiveness of VEGF inhibitors 28 .…”

Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy

“…While our study cohort did not include patients treated with both chemoimmunotherapy and VEGF inhibitors, post-hoc analyses from the IMpower-150 trial involving NSCLC patients with liver metastases have indicated that those who received a combination of carboplatin, paclitaxel, atezolizumab, and bevacizumab experienced improved outcomes compared to those who received only bevacizumab and chemotherapy [ 32 ]. A recent meta-analysis highlighted that the addition of VEGF inhibition has demonstrated the potential to enhance the response to immunotherapy in liver metastases, both in NSCLC and other cancers [ 55 ]. This introduces a potential treatment avenue for patients with liver metastases that requires further prospective evaluation.…”