Hepatic arterial infusion chemotherapy versus systemic therapy for advanced hepatocellular carcinoma: a systematic review and meta-analysis

Hyeon-Jong Kim; Seung Hyuk Lee; Hyun Jeong Shim; Hyun Jin Bang; Sang Hee Cho; Ik-Joo Chung; Eu Chang Hwang; Jun Eul Hwang; Woo Kyun Bae

doi:10.3389/fonc.2023.1265240

Hepatic arterial infusion chemotherapy versus systemic therapy for advanced hepatocellular carcinoma: a systematic review and meta-analysis

Front Oncol. 2023 Oct 10:13:1265240. doi: 10.3389/fonc.2023.1265240. eCollection 2023.

Authors

Hyeon-Jong Kim¹, Seung Hyuk Lee¹, Hyun Jeong Shim¹, Hyun Jin Bang¹, Sang Hee Cho¹, Ik-Joo Chung¹, Eu Chang Hwang², Jun Eul Hwang¹, Woo Kyun Bae¹

Affiliations

¹ Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Republic of Korea.
² Department of Urology, Chonnam National University Medical School, Hwasun, Republic of Korea.

Abstract

Introduction: To investigate the effects of hepatic arterial infusion chemotherapy (HAIC) with or without systemic chemotherapy compared to systemic chemotherapy alone in patients with locally advanced hepatocellular carcinoma (HCC).

Methods: Following a registered protocol (PROSPERO 2023 CRD42023386780 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023386780), a comprehensive search was performed using reputable databases and registries up to December 26, 2022, with no language, publication date, or status restrictions. Only randomized controlled trials (RCTs) investigating the effects of HAIC with or without systemic chemotherapy versus systemic therapy alone were included. The primary outcomes were overall survival (OS), progression-free survival (PFS), and adverse events. The secondary outcomes included the objective response rate (ORR) and disease control rate (DCR). A random-effects model was used, and the certainty of the evidence was rated using GRADE.

Results: Seven RCTs involving 1,010 patients were included. All trials utilized sorafenib as the comparator. Five trials (690 patients) compared HAIC plus sorafenib to sorafenib alone, while two trials (320 patients) compared HAIC to sorafenib. The results indicate that HAIC, with or without sorafenib, may increase OS, PFS, and ORR compared with sorafenib alone. HAIC may enhance DCR, but the evidence is very uncertain. Adverse events were comparable between HAIC plus sorafenib and sorafenib alone. However, adverse events might be decreased in HAIC alone.

Discussion: HAIC with or without systemic chemotherapy may improve survival outcomes and response rates of patients with HCC. Since the current body of evidence is moderate to very low, more robust randomized trials are needed to confirm the efficacy of HAIC.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=386780, identifier CRD42023386780.

Keywords: GRADE approach (MeSH); carcinoma; drug therapy; hepatocellular carcinoma; intra-arterial infusions; survival.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Bio & Medical Technology Development Program of NRF (NRF-2020M3A9G3080281) and NRF grant (NRF-2020R1A5A2031185) funded by MSIT to WB.