Please use this identifier to cite or link to this item: https://ninho.inca.gov.br/jspui/handle/123456789/15738
Title: Efficacy and safety associated with immune checkpoint inhibitors in unresectable hepatocellular carcinoma: a meta-analysis
Authors: Jácome, Alexandre Andrade dos Anjos
Castro, Ana Carolina Guimarães de
Vasconcelos, João Paulo Solar
Silva, Maria Helena
Lessa, Marco Antônio Oliveira
Moraes, Eduardo Dias de
Andrade, Aline Cristina
Lima, Frederico
Farias, João Paulo Fogacci de
Gil, Roberto de Almeida
Prolla, Gabriel
Garicochea, Bernardo
Keywords: Carcinoma Hepatocelular
Carcinoma, Hepatocellular
Inibidores da Angiogênese
Angiogenesis Inhibitors
Inhibidores de la Angiogénesis
Terapia Neoadjuvante
Neoadjuvant Therapy
Terapia Neoadyuvante
Issue Date: 2021
Publisher: JAMA Network Open
Citation: JÁCOME, Alexandre Andrade dos Anjos et al. Efficacy and Safety Associated With Immune Checkpoint Inhibitors in Unresectable Hepatocellular Carcinoma. JAMA Network Open, v. 12, n. 4, p. 1-11, 2021.
Abstract: IMPORTANCE Immune checkpoint inhibitors (ICIs) have yielded conflicting results in hepatocellular carcinoma (HCC). The overall effect of ICIs compared with standard therapies in unresectable HCC requires more research. OBJECTIVE To estimate the efficacy and safety associated with ICIs compared with standard therapies in patients with unresectable HCC. DATA SOURCES PubMed, Cochrane Library, Web of Science, Latin American and Caribbean Health Sciences Literature, and American Society of Clinical Oncology and European Society of Medical Oncology meeting proceedings were systematically searched. Reference lists from studies selected by electronic searching were manually searched to identify additional relevant studies. The search included literature published or presented from February 2010 to February 2020. STUDY SELECTION From December 2019 to February 2020, independent reviewers evaluated each database, scanning the title, abstract, and keywords of every record retrieved. Full articles were further assessed if the information given suggested that the study was a randomized clinical trial (RCT) comparing ICIs vs standard therapies in the treatment of unresectable HCC. DATA EXTRACTION AND SYNTHESIS The full text of the resulting studies and extracted data were reviewed independently according to PRISMA guidelines. Summary hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS) were calculated by a random-effects model. The likelihood of ICIs being associated with overall response rate (ORR) and treatment-related adverse events (TRAEs) was expressed by odds ratios (ORs) using a random-effects model. MAIN OUTCOMES AND MEASURES The main outcomes were OS, PFS, ORR, and TRAEs. RESULTS Of 1836 studies yielded by the search, 3 were retained, totaling 1657 patients (985 treated with ICIs vs 672 receiving standard treatment). Two studies evaluated ICIs as monotherapy, and 1 study investigated the combination of ICIs with bevacizumab. Compared with standard therapies (sorafenib in first-line therapy or placebo in second-line therapy), ICIs were associated with significantly improved OS (HR, 0.75; 95% CI, 0.62-0.92; P = .006), PFS (HR, 0.74; 95% CI, 0.56-0.97; P = .03), and ORR (OR, 2.82; 95% CI 2.02-3.93; P < .001). The probability of grade 3 or 4 TRAEs was lower with ICIs than with sorafenib (OR, 0.44; 95% CI, 0.20-0.96; P = .04). CONCLUSIONS AND RELEVANCE This meta-analysis found superior efficacy and safety associated with ICIs compared with standard therapies and highlights the survival benefit associated with the combination of antiangiogenic therapy with ICIs in first-line systemic therapy of unresectable HCC.
Description: p. 1-11.: il. p&b.
URI: https://ninho.inca.gov.br/jspui/handle/123456789/15738
Appears in Collections:Roberto de Almeida Gil

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