| Purpose:Liver cancer is a disease with high cancer mortality.Most of the patients with liver cancer are in advanced stage at the time of discovery due to their own or external factors,and the treatment options available are limited.Remvastinib is an oral tyrosinase inhibitor,which can inhibit tumor growth by inhibiting the formation of tumor blood vessels,inhibit the formation of lymphatic vessels and delay tumor metastasis.While Remvastinib brings benefits to patients with liver cancer,more and more scholars are studying whether the combination therapy based on Remvastinib can bring greater benefits to patients with liver cancer;Whether there will be corresponding adverse reactions during the combined treatment.The purpose of this study is to evaluate the efficacy and safety of different combined therapies based on lovatinib in patients with advanced unresectable liver cancer.method:The Chinese and English databases,including CNKI,VIP,Wanfang database,Chinese Biomedical Literature(CBM),Pub Med,Cochrane Library,Scopus,Embase,Webof Science,were comprehensively searched by computer.The search content is all the studies published between January 1995 and January 2023 on the treatment of liver cancer with different combined regimens based on lovatinib.Through browsing the title and abstract of the article,preliminary screening is carried out,and then through obtaining the full text and reading the full text,screening is carried out again according to the established inclusion and exclusion criteria,and the basic information of the article is summarized into a table;Finally,stata17 statistical analysis software will be selected to process the data.result:A total of 13 articles were included,with a total of 1708 study subjects.The o bjective response rate,disease control rate,median progression free survival time,m edian survival time,and common adverse reactions(proteinuria,elevated ALT,hyper tension,and hand foot syndrome)defined in the tumor evaluation standard ECIST1.1 were used as outcome indicators.Traditional meta-analysis results showed that wh en the objective response rate was used as the outcome indicator,Two combinations based on lenvatinib can improve the objective response rate more than lenvatinib alo ne(OR=2.4795% [1.84-3.33]);Three combinations based on lenvatinib can improve the objective response rate more than two combinations(OR=2.3995% [1.63-3.49]);In terms of disease control rate as the outcome indicator,the combination of two dru gs can improve the disease control rate more than the single drug of lenvatinib(OR=2.5295% [1.75-3.64]);Three combinations can improve disease control rates compar ed to two combinations(OR=2.2695% [1.75-3.59]);Among the outcome indicators,median progression free survival was improved by three combinations compared to t he combination of lenvatinib and two combinations(MD=0.5795% [0.33-0.82];MD=0.6895% [0.48-0.88]).In the comparison between the two combinations and lenvati nib,the combination had a better effect(MD=0.6295% [0.42-0.81]).The results of th e network meta-analysis showed that when using objective remission rate as the outc ome indicator,13 articles were included,with lenvatinib+HAIC+PD-1(89.6)>lenvati nib+TACE+PD-1(89.5)>lenvatinib+TACE(54.7)>lenvatinib+PD-1(45.5)>TACE(10.7)>lenvatinib(10);When using disease control rate as the outcome indicator,13 arti cles were included,with lenvatinib+TACE+PD-1(99.4)>lenvatinib+TACE(69.6)>le nvatinib+HAIC+PD-1(58.2)>TACE(45.5)>lenvatinib+PD-1(26.5)>lenvatinib(0.7);When using median progression free survival as the outcome measure,7 articles we re included,with lenvatinib+TACE+PD-1(100)>TACE(67.6)>lenvatinib+TACE(64.2)>lenvatinib+HAIC+PD-1(48.2)>lenvatinib(17.1)>lenvatinib+PD-1(2.9);When using median survival as the outcome measure,four articles were included: lenvatini b+TACE+PD-1(99.3)>lenvatinib+TACE(52)>TACE(44.1)>lenvatinib(4.6);Amon g common adverse reactions,the treatment regimen based on lenvatinib,lenvatinib+TACE,effectively reduces the occurrence of 1-4 grade adverse reactions and 3-4 gra de adverse reactions compared to other combination treatment regimens.Among the common adverse reactions,lenvatinib +TACE can effectively reduce the occurrence of adverse reactions compared with other combined therapies.Conclusion:Compared with single drug therapy,the combination therapy based on lenvatinib can improve the efficacy and increase the incidence of adverse reactions;The combination therapy of lenvatinib+TACE+PD-1 showed better efficacy in various efficacy indicators compared to other regimens. |
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