Immunotherapy improved the efficacy of TACE or TACE plus MTTs in HCC patients: A meta-analysis

IF 4.8 2区医学 Q2 IMMUNOLOGY International immunopharmacology Pub Date : 2025-02-06 DOI:10.1016/j.intimp.2024.114006

Yusheng Guo , Zhenliang Pan , Xuefeng Kan , Tianxiang Li , Bingxin Gong , Yi Li , Lian Yang , Chuansheng Zheng

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Abstract

Background

Although several studies have compared the efficacy and safety of transarterial chemoembolization (TACE) without immune checkpoint inhibitors (ICIs) and TACE with ICIs, there is still a lack of meta-analysis.

Methods

PubMed, Embase, Web of Science, and the Cochrane Library were searched until July 2023 for studies comparing the efficacy and safety of TACE without ICIs (TACE ± molecular targeted therapies [MTTs]) and TACE without ICIs (TACE ± MTTs + ICIs). Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs).

Results

A total of 20 studies involving 2587 HCC patients were included in the meta-analysis. Eighteen studies including 2116 patients looked at the difference in OS between TACE ± MTTs or TACE ± MTTs + ICIs. Compared with TACE ± MTTs, TACE ± MTTs + ICIs were associated with significantly improved OS (HR, 0.37; 95 % CI, 0.30–0.46). Thirteen studies including 1650 patients investigated the difference in PFS between TACE ± MTTs or TACE ± MTTs + ICIs. The outcome showed that TACE ± MTTs + ICIs were associated with longer PFS (HR, 0.50; 95 % CI, 0.41–0.61, P < 0.001). Eighteen studies including 1971 patients investigated the difference in tumor response (ORR and DCR) between TACE ± MTTs or TACE ± MTTs + ICIs. The outcomes indicated that TACE ± MTTs + ICIs bring higher ORR and DCR compared to TACE ± MTTs (ORR: OR, 2.39; 95 % CI, 1.97–2.89, P < 0.001; DCR: OR, 2.30; 95 % CI, 1.84–2.88). Moreover, to look at the direct impact of ICIs, we investigated the difference in OS, PFS, ORR, DCR, AEs, and severe AEs between TACE + tyrosine kinase inhibitors (TKIs) and TACE + TKIs + ICIs. The results indicated that the addition of ICIs provided longer OS, longer PFS, higher ORR, and higher DCR, but did not bring additional AEs and severe AEs.

Conclusion

Immune checkpoint inhibitors improved the efficacy of TACE or TACE plus MTTs and prolonged the survival of patients with hepatocellular carcinoma. Meanwhile, the addition of immune checkpoint inhibitors to the TACE + TKIs did not bring additional adverse events.

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免疫疗法提高TACE或TACE加MTTs治疗HCC患者的疗效：一项荟萃分析。

背景：虽然有几项研究比较了不使用免疫检查点抑制剂（ICIs）的经动脉化疗栓塞（TACE）和使用ICIs的经动脉化疗栓塞（TACE）的疗效和安全性，但仍然缺乏meta分析。方法：检索PubMed、Embase、Web of Science和Cochrane Library，检索截至2023年7月的研究，比较不含ICIs的TACE （TACE±分子靶向治疗[MTTs]）和不含ICIs的TACE （TACE±MTTs + ICIs）的疗效和安全性。结果包括总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、疾病控制率（DCR）和不良事件（ae）。结果：meta分析共纳入20项研究，涉及2587例HCC患者。包括2116例患者的18项研究观察了TACE±mts或TACE±mts + ICIs的OS差异。与TACE±MTTs相比，TACE±MTTs + ICIs与OS的显著改善相关(HR, 0.37；95% ci, 0.30-0.46)。13项研究包括1650例患者调查了TACE±MTTs或TACE±MTTs + ICIs的PFS差异。结果显示，TACE±MTTs + ICIs与更长的PFS相关(HR, 0.50；结论：免疫检查点抑制剂可提高TACE或TACE联合MTTs的疗效，延长肝细胞癌患者的生存期。同时，在TACE + TKIs中加入免疫检查点抑制剂并没有带来额外的不良事件。

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来源期刊

International immunopharmacology 医学-免疫学

CiteScore

8.40

自引率

3.60%

发文量

935

审稿时长

53 days

期刊介绍： International Immunopharmacology is the primary vehicle for the publication of original research papers pertinent to the overlapping areas of immunology, pharmacology, cytokine biology, immunotherapy, immunopathology and immunotoxicology. Review articles that encompass these subjects are also welcome. The subject material appropriate for submission includes: • Clinical studies employing immunotherapy of any type including the use of: bacterial and chemical agents; thymic hormones, interferon, lymphokines, etc., in transplantation and diseases such as cancer, immunodeficiency, chronic infection and allergic, inflammatory or autoimmune disorders. • Studies on the mechanisms of action of these agents for specific parameters of immune competence as well as the overall clinical state. • Pre-clinical animal studies and in vitro studies on mechanisms of action with immunopotentiators, immunomodulators, immunoadjuvants and other pharmacological agents active on cells participating in immune or allergic responses. • Pharmacological compounds, microbial products and toxicological agents that affect the lymphoid system, and their mechanisms of action. • Agents that activate genes or modify transcription and translation within the immune response. • Substances activated, generated, or released through immunologic or related pathways that are pharmacologically active. • Production, function and regulation of cytokines and their receptors. • Classical pharmacological studies on the effects of chemokines and bioactive factors released during immunological reactions.