Efficacy and safety of sorafenib plus hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma.

Abstract

BACKGROUND\nSorafenib is the standard treatment for patients with advanced HCC with improvement in survival and radiologic progression of the disease. Recently, few studies have advocated the Sorafenib\xa0+\xa0HAIC combination therapy results in better overall survival and progression-free survival than Sorafenib monotherapy in patients with advanced HCC. Herein, we aim to identify the best possible treatment option among the above two lines of therapy for patients with advanced HCC.\n\n\nMETHODS\nThe fixed effects and a random-effects model were used to perform a meta-analysis for overall response rate overall survival, and adverse events. Subgroup analysis of the data of univariate analysis in each included trial was performed to identify the specific patient population who could be benefitted from the combination therapy.\n\n\nRESULTS\nFour RCTs containing 609 patients were included in the final analysis. The overall response rate (OR: 3.81; 95% CI 1.01 to 14.42; P\xa0=\xa00.05) and overall survival (HR: 0.70; 95% CI 0.40 to 1.24; P\xa0>\xa00.05) were comparable. Subgroup analysis of OS showed that patients with Child-Pugh score B (HR: 0.30; 95% CI 0.13 to 0.72; P\xa0<\xa00.05) and AFP <400\xa0ng/ml (HR: 0.72; 95% CI 0.52 to 0.99; P\xa0<\xa00.05) were associated with significantly improved survival in the Sorafenib\xa0+\xa0HAIC group. Bone marrow suppression (OR: 3.76; 95% CI 2.58 to 5.48; P\xa0<\xa00.001) was significantly higher in the Sorafenib\xa0+\xa0HAIC group, but hepatic function impairment, constitutional symptoms, gastrointestinal events, and dermatological events were comparable (p\xa0>\xa00.05).\n\n\nCONCLUSIONS\nPatients with Child-Pugh score B and AFP <400\xa0ng/ml may be benefited most from Sorafenib\xa0+\xa0HAIC combination therapy.