Comparative efficacy of immune checkpoint inhibitor-based regimens versus tyrosine kinase inhibitors in advanced hepatocellular carcinoma stratified by etiology: a systematic review and meta-analysis
3 days ago
- #Tyrosine kinase inhibitors
- #Immune checkpoint inhibitors
- #Hepatocellular carcinoma
- Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality with limited treatment success in advanced stages.
- Tyrosine kinase inhibitors (TKIs) like sorafenib and lenvatinib are first-line treatments but have modest survival benefits and toxicity.
- Immune checkpoint inhibitors (ICIs) show promise, but direct comparisons with TKIs stratified by HCC etiology are lacking.
- A systematic review and meta-analysis compared ICI-based regimens with TKI monotherapies for advanced HCC.
- ICI-based regimens significantly improved overall survival (HR = 0.81) and progression-free survival (HR = 0.76) compared to TKIs.
- ICIs also showed better objective response rate (RR = 1.59) and disease control rate (RR = 1.10) than TKIs.
- ICIs had a lower risk of adverse events of any grade and grades 3-4 compared to TKIs.
- Subgroup analyses revealed significant survival benefits for ICIs in HBV-related HCC (HR = 0.70) but not in HCV-related or non-viral HCC.
- ICI-based therapies provided survival benefits primarily in patients with preserved liver function (CTP A).
- Patients with impaired liver function (CTP B/C) did not receive significant benefits from ICIs.
- ICI-based therapies are more effective and better tolerated than TKI monotherapies, especially in HBV-related HCC and preserved liver function.