PMID- 33869060
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220422
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 11
DP  - 2021
TI  - Efficacy of First Line Systemic Chemotherapy and Multikinase Inhibitors in 
      Advanced Hepatocellular Carcinoma: A Systematic Review and Network Meta-Analysis.
PG  - 654020
LID - 10.3389/fonc.2021.654020 [doi]
LID - 654020
AB  - BACKGROUND: Hepatocellular carcinoma (HCC) is the third most fatal cancer, with a 
      5-year survival rate of 18%. Standard frontline-therapy is multikinase inhibitors 
      (MKIs), but accessibility is still limited, particularly in developing countries. 
      This network meta-analysis (NMA) aimed to compare the efficacy of usual 
      chemotherapy vs MKIs. METHOD: Randomised-controlled trials (RCTs) comparing any 
      among chemotherapy vs MKIs in treatment-naive patients with advanced HCCs were 
      identified from MEDLINE and SCOPUS databases. Overall survival (OS) and 
      progression-free survival (PFS) probabilities and times were extracted from 
      Kaplan-Meier curves using Digitizer, and then converted to individual patient 
      time-to-event data. A one-stage mixed-effect survival model was applied to 
      estimate median OS and PFS. A two-stage NMA was applied for the overall response 
      rate and adverse events (AEs) outcome. RESULTS: A total of 20 RCTs were eligible 
      for NMA. Lenvatinib was the best treatment among single MKIs, with median OS and 
      PFS of 9 and 6.3 months, without significant differences in AEs relative to other 
      MKIs. Median OS and PFS were 0.70 (-0.42, 1.83) and 2.17 (1.41, 2.93) months 
      longer with Lenvatinib than Sorafenib. Among chemotherapy agents, FOLFOX4 had the 
      longest median OS and PFS at 7.9 and 4.3 months, respectively, without 
      significant AEs compared to other chemotherapies. The combination of 
      Sorafenib+Doxorubicin prolonged median OS and PFS to 12.7 and 6.3 months, 
      respectively. CONCLUSION: Use of the MKIs Lenvatinib or Sorafenib as first line 
      systemic treatment for advanced HCC could be beneficial. However, FOLFOX4 might 
      be the optimal choice in a developing country where the health-care budget is 
      limited.
CI  - Copyright (c) 2021 Oranratnachai, Rattanasiri, Pooprasert, Tansawet, 
      Reungwetwattana, Attia and Thakkinstian.
FAU - Oranratnachai, Songporn
AU  - Oranratnachai S
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
AD  - Oncology Clinic, Sriphat Medical Center, Faculty of Medicine, Chiang Mai 
      University, Chiang Mai, Thailand.
FAU - Rattanasiri, Sasivimol
AU  - Rattanasiri S
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
FAU - Pooprasert, Anantaporn
AU  - Pooprasert A
AD  - Oncology Unit, Division of Internal Medicine, Uttaradit Hospital, Uttaradit, 
      Thailand.
FAU - Tansawet, Amarit
AU  - Tansawet A
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
AD  - Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj 
      University, Bangkok, Thailand.
FAU - Reungwetwattana, Thanyanan
AU  - Reungwetwattana T
AD  - Division of Medical Oncology, Department of Medicine, Faculty of Medicine 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
FAU - Attia, John
AU  - Attia J
AD  - Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public 
      Health, Hunter Medical Research Institute, University of Newcastle, New Lambton, 
      NSW, Australia.
FAU - Thakkinstian, Ammarin
AU  - Thakkinstian A
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
LA  - eng
PT  - Systematic Review
DEP - 20210331
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC8044881
OTO - NOTNLM
OT  - chemotherapy
OT  - first-line systemic treatment
OT  - hepatocellular carcinoma
OT  - multikinase inhibitors
OT  - network meta-analysis
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/04/20 06:00
MHDA- 2021/04/20 06:01
PMCR- 2021/01/01
CRDT- 2021/04/19 06:32
PHST- 2021/01/15 00:00 [received]
PHST- 2021/03/15 00:00 [accepted]
PHST- 2021/04/19 06:32 [entrez]
PHST- 2021/04/20 06:00 [pubmed]
PHST- 2021/04/20 06:01 [medline]
PHST- 2021/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2021.654020 [doi]
PST - epublish
SO  - Front Oncol. 2021 Mar 31;11:654020. doi: 10.3389/fonc.2021.654020. eCollection 
      2021.