Selection of first-line systemic therapies for advanced hepatocellular carcinoma:A network meta-analysis of randomized controlled trials

作     者：Yue Han Wei-Hua Zhi Fei Xu Chen-Bo Zhang Xiao-Qian Huang Jian-Feng Luo 

作者机构：Department of Interventional TherapyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of BiostatisticsSchool of Public HealthFudan UniversityShanghai 200034China 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第19期

页      面：2415-2433页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Hepatocellular carcinoma Systemic therapy Meta-analysis Lenvatinib Firstline Immune therapy 

摘      要：BACKGROUND The majority of clinical trials of first-line systemic treatments for hepatocellular carcinoma(HCC)used placebo or sorafenib as comparators,and there are limited data providing a cross comparison of treatments in this setting,especially for newly-approved immune checkpoint inhibitor and vascular endothelial growth factor inhibitor combination *** To systematically review and compare response rates,survival outcomes,and safety of first-line systemic therapies for advanced hepatocellular *** We searched PubMed,Science Direct,the Cochrane Database,Excerpta Medica Database,and abstracts from the American Society of Clinical Oncology 2020 annual *** studies were randomized controlled trials of systemic therapy enrolling adults with advanced/unresectable *** of bias was assessed with the Cochrane risk of bias tool for randomized controlled trials.A network meta-analysis was used to synthesize data and perform direct and indirect comparisons between treatments.P value,a frequentist analog to the surface under the cumulative ranking curve,was used to rank *** In total,1398 articles were screened and 27 *** compared were atezolizumab plus bevacizumab,brivanib,donafenib,dovitinib,FOLFOX4,lenvatinib,linifanib,nintedanib,nivolumab,sorafenib,sunitinib,vandetanib,11 sorafenib combination therapies,and three other combination *** overall response rate,lenvatinib ranked 1/19,followed by atezolizumab plus bevacizumab and *** progression-free survival(PFS),atezolizumab+bevacizumab was ranked 1/15,followed by *** the exception of atezolizumab+bevacizumab[hazard ratios(HR)PFS=0.90;95%confidence interval(CI):0.64-1.25],the estimated HRs for PFS for all included treatments vs lenvatinib were1;however,the associated 95%CI passed through unity for bevacizumab plus erlotinib,linifanib,and *** overall survival,atezolizumab plus bevacizumab was ranked 1/25,followed by