Meta-analysis of the efficacy and safety of PD-1/PD-L1 inhibitors administered alone or in combination with anti-VEGF agents in advanced hepatocellular carcinoma

We read with great interest the article by Gerbes et al, 1 which indicated the prospects of immune-based therapies in hepatocellular carcinoma (HCC) and that by Zhu et al, 2 which proposed their new strategy for sensitising HCC to anti-programmed death-ligand 1 (PD-L1) blockade. As they suggest, immunotherapy for HCC has great potential, and combination therapy may further improve survival benefits. Many patients with HCC have advanced stage disease (aHCC) at the time of diagnosis, and some of them even have progressive disease after first-line therapy. Recently, the clinical benefits of immunotherapy for HCC have emerged. Blocking the PD‐1/PD‐L1 signalling pathway with humanised monoclonal antibodies is effective in alleviating immune escape and enhancing T cell‐mediated antitumour immunity. However, no more than 20% of patients with HCC robustly respond to anti-programmed cell death protein 1 (PD-1)/PD-L1 monotherapy.3 4 The combination of anti-vascular endothelial growth factor (VEGF) agents with PD‐1/PD‐L1 blockade may synergistically reverse the immunosuppressive microenvironment.5 Preclinical and …