ABSTRACT
BACKGROUND: A variety of targeted drug therapies in clinical trials have been proven to be effective for the treatment of hepatocellular carcinoma (HCC). Our study aims to compare the short-term and long-term efficacies of different targeted drugs in advanced hepatocellular carcinoma (AHCC) treatment using a network meta-analysis approach. METHODS: PubMed, Embase, Ovid, EBSCO, and Cochrane central register of controlled trials were searched for randomized controlled trials (RCTs) of different targeted therapies implemented to patients with AHCC. And the retrieval resulted in 7 targeted drugs, namely, sorafenib, ramucirumab, everolimus, brivanib, tivantinib, sunitinib, and sorafenib+erlotinib. Direct and indirect evidence were combined to evaluate stable disease (SD), progressive disease (PD), complete response (CR), partial response (PR), disease control rate (DCR), overall response ratio (ORR), overall survival (OS), and surface under the cumulative ranking curve (SUCRA) of patients with AHCC. RESULTS: A total of 11 RCTs were incorporated into our analysis, including 6594 patients with AHCC, among which 1619 patients received placebo treatment and 4975 cases had targeted therapies. The results revealed that in comparison with placebo, sorafenib, and ramucirumab displayed better short-term efficacy in terms of PR and ORR, and brivanib was better in ORR. Regarding long-term efficacy, sorafenib and sorafenib+erlotinib treatments exhibited longer OS. The data of cluster analysis showed that ramucirumab or sorafenib+erlotinib presented relatively better short-term efficacy for the treatment of AHCC. CONCLUSION: This network meta-analysis shows that ramucirumab and sorafenib+erlotinib may be the better targeted drugs for AHCC patients, and sorafenib+erlotinib achieved a better long-term efficacy.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Carcinoma, Hepatocellular/drug therapy , Erlotinib Hydrochloride/administration & dosage , Liver Neoplasms/drug therapy , Molecular Targeted Therapy , Niacinamide/analogs & derivatives , Phenylurea Compounds/administration & dosage , Antibodies, Monoclonal, Humanized , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Disease-Free Survival , Female , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Neoplasm Invasiveness/pathology , Neoplasm Staging , Niacinamide/administration & dosage , Prognosis , Randomized Controlled Trials as Topic , Risk Assessment , Sorafenib , Survival Analysis , Treatment Outcome , RamucirumabABSTRACT
BACKGROUND: To evaluate the relative effectiveness of different treatments of hepatocellular carcinoma (HCC) via the hepatic artery. MATERIALS AND METHODS: The study sample group consisted of 418 patients who were randomly selected from 2008 to 2012 with a first diagnosis of HCC and treated with transcatheter arterial chemoembolization (TACE) or without (TAE) chemotherapy or transcatheter arterial infusion (TAI). We collected data including tumor size preoperative and one month thereafter to compare change in areas across the three groups, along with various laboratory indexes for comparison. RESULTS: The overall average change of areas was 240.8 ± 72.1 mm2. In the three groups it was 265.0 ± 58.0 mm2 vs. 250.5 ± 51.9 mm2 vs. 123.7 ± 26.2 mm2. In groups TACE and TAE values were larger than in group TAI (p<0.01), but the difference between the two was not statistically significant (p= 0.191). Additionally, U/L change of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in groups TACE and TAE was greater than in the TAI cases (24.0 ± 13.5 vs. 20. 9± 12.1 vs. 5.47 ± 8.20 and 25.6 ± 13.5 vs.23.2 ± 12.28 vs.5.48 ± 14.3) on the preoperative day and two days thereafter (p<0.01). Between the two groups there was no significant cariation (p= 0.320 and p= 0.609). However, the AST and ALT recovered to normal levels one month later on therapy with liver protecting drugs. CONCLUSION: The groups TACE and TAE demonstrated more effective reduction of tumor size than group TAI. While lipiodol caused acute liver function damage, this proved reversible.
