Efficacy and safety of hepatic artery infusion chemotherapy conjunction with tyrosine kinase inhibitors and programmed death-1 inhibitors for unresectable/advanced hepatocellular carcinoma: a meta-analysis

The safety and therapeutic efficiency of tyrosine kinase inhibitors (TKIs) and programmed death-1 (PD-1) inhibitors in combination with hepatic artery infusion chemotherapy (HAIC) for patients with unresectable/advanced hepatocellular carcinoma (HCC) require further investigation. This meta-analysis aimed to thoroughly investigate the safety and efficacy of this triple combination therapy based on currently available research. PubMed, Embase, Cochrane Library, Web of Science, VIP, Wan Fang, and China National Knowledge Infrastructure were searched. Outcomes included complete response (CR), partial response (PR), stable disease, overall survival, progression-free survival, and treatment/laboratory-related adverse events. Stata15.1 software was used for random/fixed-effect model analysis. Ten studies with 1108 patients were incorporated in the analysis. For efficacy, the triple combination therapy achieved an improved CR rate [relative risk (RR): 2.76, 95% confidence interval (CI): 1.43-5.33] and PR rate (RR: 1.70, 95% CI: 1.01-2.86) than the control group. Moreover, the triple combination therapy decreased the 44% risk of death [hazard ratio (HR): 0.56, 95% CI: 0.46-0.67] and 37% risk of disease progression (HR: 0.63, 95% CI: 0.53-0.75) compared with the control group. The triple combination therapy group and the control group did not exhibit a statistical difference in treatment- or laboratory-related adverse events. In the management of unresectable/advanced HCC, HAIC in conjunction with PD-1 inhibitors and TKI exhibits both safety and efficacy, providing a scientific basis for clinical practice.