Comparing the efficacy of five first-line treatment regimens for unresectable hepatocellular carcinoma: A network meta-analysis of randomized controlled trials

Background: To find ideal treatment regimens in unresectable hepatocellular carcinoma (u-HCC) are clinically important. This study evaluated the efficacy of five first-line regimens in u-HCC patients at 6-, 12-, 18-, 24-, and 30-month overall survival (OS) to provide reference for rational clinical treatment. Methods: We performed a systematic search using five databases. Screening and including qualified randomized controlled trials (RCT) regarding to the first-line regimens for unresectable HCC. Odds ratios (OR) were generated for dichotomous variants by network meta-analysis. The primary endpoint was OS, and the secondary endpoint was progression-free survival (PFS). The software implemented was STATA 17.0 MP. Results: Eventually, a total of six RCTs with five first-line regimens were included. HAIC-FO (OR=9.78, 95%CI: 4.21 to 22.69) was significantly superior to sorafenib on OS at 18th month. Concurrently, HAIC-FO (SUCRA=100%) had the highest ranking compared with the rest regimens. Atezolizumab plus bevacizumab (OR=5.13, 95%CI: 2.28 to 11.54) showed significantly better efficacy compared with sorafenib on PFS at 12th month. Synchronously, atezolizumab plus bevacizumab (SUCRA=87.3%) had the highest ranking. Conclusion: For patients with u-HCC, The optimal regimen we recommend is treating with HAIC-FO until 18th month, followed by sequential therapy with donafenib. Furthermore, we need more head-to-head trials to confirm these findings.