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SYSTEMATIC REVIEW article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1421520

Immune-targeted Therapy with Transarterial chemo(embolization) for Unresectable HCC: A Systematic Review and Meta-analysis

Provisionally accepted
Huipeng Fang Huipeng Fang 1,2Qiao Ke Qiao Ke 3*Shiji Wu Shiji Wu 2*Qiang Tu Qiang Tu 4*Lei Wang Lei Wang 1*
  • 1 Department of Radiation Oncology, Jiangxi Provincial Cancer Hospital, Nanchang, Jiangxi Province, China
  • 2 School of Oncology Clinical Medicine, Fujian Medical University, Fujian Provincial Cancer Hospital, Fujian, China
  • 3 First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
  • 4 Jiangxi Provincial Cancer Hospital, Nanchang, Jiangxi Province, China

The final, formatted version of the article will be published soon.

    Background: Transarterial chemo(embolization) is preferred for treating unresectable hepatocellular carcinoma (uHCC), questioned by the emerging immune-targeted therapies. This systematic review pioneers to evaluate the clinical efficacy and safety of transarterial chemo(embolization) combined with immune-targeted therapy for uHCC patients. Methods: PubMed, Embase, and Cochrane Library were searched for studies comparing immune-targeted therapy with or without transarterial chemo(embolization) until May 31, 2024. The complete response (CR) rate, objective response rate (ORR), and disease control rate (DCR) were considered to be the primary outcomes calculated for the clinical outcomes of transarterial chemo(embolization) combined with immune-targeted therapy, along with the progression-free survival (PFS) and overall survival (OS). The incidence of treatment-related severe adverse events was set as the major measure for the safety outcome. Results: Sixteen studies, encompassing 1789 patients receiving transarterial chemo(embolization) plus immune-targeted therapy and 1215 patients receiving immune-targeted therapy alone, were considered eligible. The combination of transarterial chemo(embolization) and immune-targeted therapy demonstrated enhanced outcomes in CR (OR=2.12, 95%CI=1.35-3.31), ORR (OR=2.78, 95%CI=2.15-3.61), DCR (OR=2.46, 95%CI=1.72-3.52), PFS (HR=0.59, 95%CI=0.50-0.70), and OS (HR=0.51, 95%CI=0.44-0.59), albeit accompanied by a surge in ALT (OR=2.17, 95%CI=1.28- 3.68) and AST (OR=2.28, 95%CI=1.42-3.65). The advantages of additional transarterial chemo(embolization) to immune-targeted therapy was also verified in subgroups of first-line treatment, intervention techniques, with or without extrahepatic metastasis, Child-pugh grade A or B, and with or without tumor thrombus. Conclusion: Combination of transarterial chemo(embolization) and immune-targeted therapy seems to bolster local control and long-term efficacy in uHCC, albeit at the expense of hepatic complications.

    Keywords: Transarterial chemo(embolization), Unresectable hepatocellular carcinoma, targeted agents, Immunotherapy, Systematic review

    Received: 22 Apr 2024; Accepted: 12 Jul 2024.

    Copyright: © 2024 Fang, Ke, Wu, Tu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Qiao Ke, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
    Shiji Wu, School of Oncology Clinical Medicine, Fujian Medical University, Fujian Provincial Cancer Hospital, Fujian, China
    Qiang Tu, Jiangxi Provincial Cancer Hospital, Nanchang, 330029, Jiangxi Province, China
    Lei Wang, Department of Radiation Oncology, Jiangxi Provincial Cancer Hospital, Nanchang, Jiangxi Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.