Efficacy and safety of immune checkpoint inhibitors combined with anti-angiogenic agents compared to sorafenib or lenvatinib in the treatment of unresectable or advanced hepatocellular carcinoma: a pairwise meta-analysis of randomized controlled trials

This meta-analysis establishes immune checkpoint inhibitors combined with anti-angiogenic agents as a superior first-line treatment for advanced hepatocellular carcinoma, providing significant survival benefits over sorafenib or lenvatinib monotherapy. The efficacy is particularly robust in high-risk subgroups and is meaningfully influenced by the choice of anti-angiogenic partner. Despite an increased risk of specific toxicities, the profound survival advantage and superior tumor response firmly support this combination in redefining the standard of care, with optimal application guided by patient profile and drug class selection.