Efficacy and safety of radiotherapy combined with immune checkpoint inhibitors for advanced or unresectable hepatocellular carcinoma: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'au 31 août 2024 (21 articles, 927 patients), cette méta-analyse évalue l'efficacité, du point de vue du taux de réponse objective et du taux de contrôle de la maladie, et la toxicité d'un traitement combinant radiothérapie et inhibiteurs de point de contrôle immunitaire avec ou sans agent anti-VEGF pour un carcinome hépatocellulaire de stade avancé ou non résécable
Background: To evaluate the efficacy and safety of radiotherapy with immune checkpoint inhibitors (ICIs), with or without anti-vascular endothelial growth factor (anti-VEGF) agents, in the treatment of advanced or unresectable hepatocellular carcinoma (HCC).
Methods: Databases including Web of Science, PubMed, Embase, Cochrane Library databases, American Society of Clinical Oncology, and European Society for Medical Oncology were systematically searched. The search included publications up to August 31, 2024. Primary outcome measures included objective response rate (ORR), disease control rate (DCR), incidence of treatment-related adverse events (TRAEs), and TRAEs (grade ≥3).
Results: Twenty-one articles were included in this study (927 participants). Following RECIST 1.1, for external radiotherapy combined with ICIs, the ORR and DCR were 56% (95% CI 0.48-0.64, I2=65.91%) and 88% (95% CI 0.77-0.96, I2=87.19%), respectively; for yttrium-90 combined with ICI, they were 31% (95%CI 0.20-0.43, I2=0%) and 73% (95%CI 0.48-0.92, I2=75.23%), respectively. According to CTCAE criteria, for external radiotherapy combined with ICIs, the incidence of TRAEs (all grades) was 95% (95% CI 0.89-0.98, I2=70.79%), and the incidence of TRAEs (grades ≥3) was 35% (95% CI 0.23-0.48, I2=87.54%); for yttrium-90 combined with ICIs, they were 78% (95%CI 0.48-0.98, I2=88.15%) and 22% (95%CI 0.04-0.47, I2=83.69%), respectively. Subgroup analyses indicated that sequential therapy demonstrated a higher DCR than concurrent therapy, while the combination of intensity-modulated radiotherapy, ICIs, and anti-VEGF agents showed improved efficacy but was associated with increased toxicity.
Conclusions: Radiotherapy combined with ICI demonstrates substantial efficacy and manageable safety in advanced or unresectable HCC. Sequential therapy may enhance therapeutic effectiveness while reducing TRAEs.
Critical Reviews in Oncology/Hematology , résumé 2025