A systematic literature review and network meta-analysis of first-line treatments for unresectable hepatocellular carcinoma based on data from randomized controlled trials. Issue 3 (4th March 2021)

• Record Type: Journal Article
• Authors: Pollock, Richard F.; Brennan, Victoria K.; Shergill, Suki; Colaone, Fabien
• Is Part Of: Expert review of anticancer therapy. Volume 21:Issue 3(2021)
• Page Start: 341
• Page End: 349
• Publication Date: 2021-03-04
• Subjects: Hepatocellular carcinoma -- meta-analysis -- protein-tyrosine kinases -- brachytherapy; Cancer -- Treatment -- Periodicals; 616.99406
• DOI: 10.1080/14737140.2021.1842204
• Languages: English
• ISSNs: 1473-7140

Abstract

ABSTRACT: Background: Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. First-line treatment options for unresectable HCC include sorafenib, lenvatinib, selective internal radiation therapy (SIRT), and transarterial chemoembolization (TACE). The present study reviewed randomized controlled trials (RCTs) of first-line therapies for unresectable HCC in TACE-ineligible patients. Research design and methods: A systematic literature review (SLR) was conducted to identify RCTs of first-line treatments for TACE-ineligible patients with unresectable HCC. Data on overall survival (OS) and progression-free survival were extracted and a contrast-based Bayesian network meta-analysis (NMA) was conducted using Markov Chain Monte Carlo techniques. Results: The SLR identified three RCTs: two comparing Y-90 resin microspheres with sorafenib, and one comparing sorafenib with lenvatinib. No RCTs were identified comparing other SIRT technologies with any other approved first-line HCC therapies. The NMA showed no significant OS differences between Y-90 resin microspheres and sorafenib (hazard ratio [HR] 0.92, 95% credible interval [CrI]: 0.79–1.08) or lenvatinib (HR: 0.88, 95% CrI: 0.63–1.22). Conclusions: An SLR and NMA showed no significant differences between sorafenib, lenvatinib, and Y-90 resin microspheres in treating unresectable HCC. RCT evidence was not available for any other SIRT technologies and an evaluation of their relative efficacy was therefore not possible.