Meta-analyses Of The Efficacy And Safety Of Sorafenib Combined With Hepatic Arterial Infusion Chemotherapy Versus Sorafenib Monotherapy For Unresectable Hepatocellular Carcinoma

Objective Sorafenib and hepatic arterial infusion chemotherapy are important methods for the treatment of unresectable liver cancer.We conducted a preliminary literature review and meta-analysis to evaluate the efficacy and safety of sorafenib combined with hepatic arterial infusion chemotherapy and sorafenib monotherapy for unresectable hepatocellular carcinoma.Methods Potential relevant studies were searched in Pubmed,Web of Science,Embase and the Cochrane Library published from inception to February 19,2020.A total of 4randomized controlled clinical trials met the inclusion criteria.The basic information,treatment,overall survival time,overall response rate,and adverse reactions included in the literature were extracted.Results Compared with sorafenib monotherapy,patients with unresectable hepatocellular carcinoma receiving sorafenib combined with hepatic arterial infusion chemotherapy have no statistically significant benefit in overall survival(HR=0.68,95% CI [0.39,1.21],p=0.19).Furthermore,there are no statistically significant the difference in progression-free survival was(HR=0.50,95% CI [0.22,1.13],p=0.09)and time to progression(HR=0.77,95% CI [0.57,1.04],p=0.09).The sorafenib combined with hepatic arterial infusion chemotherapy group had a higher overall response rate(OR=4.36,95% CI[1.35,14.08],p=0.01).The incidence of Diarrhea was significantly higher in the monotherapy group than in the combined treatment group(OR=0.55,95%CI [0.39,0.78],p<0.01).While the incidence of Neutropenia,Hypoalbuminemia and Vomiting in the combination treatment group was significantly higher than that of the sorafenib monotherapy group(OR=1.93,95% CI [1.37,2.71],p<0.01;OR=8.86,95%CI [1.81,43.45],p<0.01;OR=3.79,95% CI [1.34,10.70],p=0.01).Meanwhile,among grade 3-4 adverse events,the incidence of Neutropenia,Thrombocytopenia,Vomiting,and Hb decreased in the sorafenib combined hepatic infusion chemotherapy group was significantly higher than that in the sorafenib monotherapy group(OR=7.10,95% CI[2.56,19.70],p<0.01;OR=2.94,95% CI [1.04,8.31],p=0.04;OR=5.27,95% CI [1.13,24.65],p=0.03;OR=2.10,95% CI [1.06,4.15],p=0.03).Conclusion Compared with sorafenib monotherapy,sorafenib combined with hepatic artery infusion chemotherapy could not benefit patients with unresectable hepatocellular carcinoma,but could increase the incidence of adverse events.For the treatment of patients with unresectable hepatocellular carcinoma,sorafenib in combination with hepatic artery perfusion chemotherapy is not recommended.