Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2024; 30(4): 318-331
Published online Jan 28, 2024. doi: 10.3748/wjg.v30.i4.318
Hepatic arterial infusion chemotherapy with anti-angiogenesis agents and immune checkpoint inhibitors for unresectable hepatocellular carcinoma and meta-analysis
Yu-Zhe Cao, Guang-Lei Zheng, Tian-Qi Zhang, Hong-Yan Shao, Jia-Yu Pan, Zi-Lin Huang, Meng-Xuan Zuo
Yu-Zhe Cao, Guang-Lei Zheng, Tian-Qi Zhang, Hong-Yan Shao, Jia-Yu Pan, Zi-Lin Huang, Meng-Xuan Zuo, Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Yu-Zhe Cao, Guang-Lei Zheng, Tian-Qi Zhang, Hong-Yan Shao, Jia-Yu Pan, Zi-Lin Huang, Meng-Xuan Zuo, Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
Yu-Zhe Cao, Guang-Lei Zheng, Tian-Qi Zhang, Hong-Yan Shao, Jia-Yu Pan, Zi-Lin Huang, Meng-Xuan Zuo, Department of Minimally Invasive Interventional Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong Province, China
Co-first authors: Yu-Zhe Cao and Guang-Lei Zheng.
Co-corresponding authors: Zi-Lin Huang and Meng-Xuan Zuo.
Author contributions: Cao YZ, Zheng GL, Zuo MX and Huang ZL participated equally in conceptualization; Cao YZ, Zuo MX and Zheng GL made great contribution in the in the data curation, formal analysis, methodology and investigation; Zhang TQ, Shao HY and Pan JY has participated in the investigation and the validation; The project administration and supervision were accomplished by Huang ZL and Zuo MX; Cao YZ and Zheng GL had finished the original draft; Zuo MX and Huang ZL has been responsible for the review and editing; All authors have provided final approval of the manuscript version to be submitted for publication. Cao YZ and Zheng GL, contributed equally to this work and share first authorship for their contribution in conceptualization, data curation, formal analysis, methodology, investigation and draft writing. Huang ZL and Zuo MX, contributed equally to this work and are co-corresponding authors for their contribution in conceptualization, project administration, supervision, revision and approvement for final edition of the manuscript.
Supported by Natural Science Foundation of Guangdong Province, No. 2020A1515011539.
Institutional review board statement: This study was reviewed and approved by the Sun Yat-sen University Cancer Center Ethics Committee. Informed consent was waived due to the retrospective nature of the analysis.
Informed consent statement: Informed consent was waived due to the retrospective nature of the analysis, which has been approved by Ethic Committee of Sun Yat-sen University Cancer Center.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets of the manuscript is available from the corresponding authors at Sun Yat-sen University Cancer Center Research Data Deposit repository (https://www.researchdata.org.cn/). Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Meng-Xuan Zuo, MD, Attending Doctor, Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Yuexiu District, Guangzhou 510060, Guangdong Province, China. zuomx@sysucc.org.cn
Received: November 1, 2023
Peer-review started: November 1, 2023
First decision: December 4, 2023
Revised: December 11, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: January 28, 2024
ARTICLE HIGHLIGHTS
Research background

Unresectable hepatocellular carcinoma had been difficult to be treated in the past, hepatic arterial chemotherapy infusion chemotherapy (HAIC) as well as angiogenesis inhibitors plus programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1) blockers were proved to prolong the unresectable hepatocellular carcinoma (uHCC) patients' survival, respectively. Meanwhile, some phase II single arm suggested that the combination of HAIC and angiogenesis inhibitors and PD-1/PD-L1 blockers (AIPB) (triple therapy) was effective in treating uHCC. But which treatment is the best choice was still confused. The study was designed to answer the question.

Research motivation

The best first-line treatment for uHCC was unclear and there was lack of studies to compare the efficacy and safety between triple therapy and AIPB. There were so many choices that clinical staff may be confused when they need to treat uHCC patients. If we can find the relatively better regimen, it is helpful for the standardization of the uHCC treatment to improve the patients' prognosis.

Research objectives

The study aimed to identified the HAIC and HAIC-based treatments was the best choice for uHCC. Based on the result, we explored the efficacy and safety of one of HAIC-based treatment, triple therapy in the real-world condition compared to AIPB. The results of the study could be the evidence to guide clinical reasonable treatment and prospective clinical study.

Research methods

We have tried to perform a network meta-analysis to find the first choice to uHCC and identified the efficacy and safety of triple therapy compared to AIPB through a retrospective cohort study.

Research results

The network meta-analysis including 13 phase randomized controlled trials (RCTs) showed HAIC and HAIC-based treatments were likely to be the first choice to treat uHCC. HAIC plus camrelizumab plus AIPB (triple therapy) had better progression-free survival and overall survival than AIPB without HAIC for uHCC. Even though the incidence of adverse events in the triple therapy group was higher than the AIPB group, the safety of triple therapy was still acceptable.

Research conclusions

HAIC-based treatments were better than other regimens for treating uHCC. Triple therapy was more effective than AIPB in the Chinese uHCC population. All of the above results proved the significance of local treatments in the uHCC treating.

Research perspectives

There is absolutely a need for studies at the cellular or molecular level and additional large-scale prospective RCTs on this topic.