Combination therapy of sorafenib and TACE for unresectable HCC: a systematic review and meta-analysis - PubMed (original) (raw)

Review

Combination therapy of sorafenib and TACE for unresectable HCC: a systematic review and meta-analysis

Lei Liu et al. PLoS One. 2014.

Abstract

Background and aim: A large number of studies have tried to combine sorafenib with TACE for patients with unresectable hepatocellular carcinoma (HCC) and the results were controversial. We conducted this systematic review and meta-analysis to evaluate the safety and efficacy of combination therapy of sorafenib and TACE in the management of unresectable HCC.

Methods: MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Library were searched from January 1990 to October 2013 and these databases were searched for appropriate studies combining TACE and sorafenib in treatment of HCC. Two authors independently reviewed the databases and extracted the data and disagreements were resolved by discussion. Effective value and safety were analyzed. Effective value included disease control rate (DCR), time to progression (TTP) and overall survival (OS).

Results: 17 studies were included in the study. In the 10 noncomparative studies, DCR ranged from 18.4 to 91.2%. Median TTP ranged from 7.1 to 9.0 months, and median OS ranged from 12 to 27 months. In the 7 comparative studies, the hazard ratio (HR) for TTP was found to be 0.76 (95% CI 0.66-0.89; P<0.001) with low heterogeneity among studies (P = 0.243; I(2) = 25.5%). However, the HR for OS was found to be 0.81 (95% CI 0.65-1.01; P = 0.061) with low heterogeneity among studies (P = 0.259; I(2) = 25.4%). The common toxicities included fatigue, diarrhea, nausea, hand foot skin reaction (HFSR), hematological events, hepatotoxicity, alopecia, hepatotoxicity, hypertension and rash/desquamation. AEs are generally manageable with dose reductions.

Conclusions: Combination therapy may bring benefits for unresectable HCC patients in terms of TTP but not OS. Further well-designed randomized controlled studies are needed to confirm the efficacy of combination therapy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of the study selection procedure.

Figure 2. Forest plot showing the associations of the time to progression (TTP) between TACE alone group and sorafenib combined with TACE group for patients with unresctable HCC.

The result of meta-analysis for TTP between TACE alone group and sorafenib combined with TACE group for patients with unresctable HCC. Studies are arranged by publication year. Forrest plot displayed as hazard ratio and 95% confidence intervals. (HR, hazard ratio; CI, confidence interval).

Figure 3. Forest plot showing the associations of the overall survival (OS) between TACE alone group and sorafenib combined with TACE group for patients with unresctable HCC.

The result of meta-analysis for OS between TACE alone group and sorafenib combined with TACE group for patients with unresctable HCC.Studies are arranged by publication year. Forrest plot displayed as hazard ratio and 95% confidence intervals. (HR, hazard ratio; CI, confidence interval).

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Combination therapy of sorafenib and TACE for unresectable HCC: a systematic review and meta-analysis - PubMed (original) (raw)