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Oncology

Study identifies optimal treatment options for advanced hepatocellular carcinoma

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A comprehensive study involving 23 randomized controlled trials has shed light on optimal treatment options for advanced hepatocellular carcinoma (HCC).

In the first-line treatment, the combination of a PD-1 inhibitor with bevacizumab and the combination of PD-1 inhibitors with TKIs or bevacizumab demonstrated significant efficacy in extending overall survival and reducing the risk of progression-free survival events. For patients with absolute contraindications to VEGF inhibitors, dual immunotherapy is recommended. In the second-line treatment, regorafenib and cabozantinib were identified as the most effective options, offering valuable guidance for clinicians navigating the complex landscape of advanced HCC treatment.

The study, which involved 14,703 patients with advanced HCC, examined 15 first-line and 8 second-line treatments. In the realm of first-line therapy, findings revealed that the combination of a PD-1 inhibitor with bevacizumab exhibited a significant extension of overall survival (1/15). Additionally, combinations involving PD-1 inhibitors with TKIs (1/15) and PD-1 inhibitors with bevacizumab (2/15) demonstrated heightened efficacy in reducing the risk of progression-free survival events.

In second-line therapy, a network meta-analysis showcased that all investigational agents outperformed placebos in prolonging progression-free survival. Cabozantinib emerged as the top performer (1/7), though it was noted that only cabozantinib, regorafenib, ramucirumab, and pembrolizumab translated this advantage into overall survival benefits, with regorafenib securing the highest ranking (1/7).

Reference
Wu D, Jia B, Jia M, et al. Comparative efficacy and safety of systemic therapy for advanced hepatocellular carcinoma: a systematic review and network meta-analysis. Front Oncol. 2023;13:1274754. doi: 10.3389/fonc.2023.1274754. PMID: 38125936; PMCID: PMC10730675.

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