Efficacy and safety of transarterial chemoembolization plus lenvatinib in the treatment of advanced hepatocellular carcinoma: A meta-analysis

Background: The benefits of transarterial chemoembolization (TACE) plus lenvatinib in advanced hepatocellular carcinoma (HCC) remain controversial. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of TACE plus lenvatinib in the treatment of advanced HCC.Methods: Up to February 26, 2023, the databases of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure, and Wanfang were searched, and clinical studies of TACE plus lenvatinib (experimental group) versus TACE or lenvatinib (control group) in the treatment of advanced HCC were included. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included literature. Revman5.4 software was used for meta-analysis.Results: A total of 1855 patients were included in 18 studies. The results of the meta-analysis showed that TACE plus lenvatinib could increase the objective response rate (ORR) (odds ratio [OR] = 3.25, 95% confidence interval [CI]: 2.46-4.31; OR = 3.55, 95%CI: 2.53-4.97) and disease control rate (DCR) (OR = 3.27, 95%CI: 2.44-4.38; OR = 3.45, 95%CI: 2.28-5.24), 12-month (OR = 3.43, 95%CI: 2.08-5.65; OR = 2.78, 95%CI: 1.90-4.05) and 18-month (OR = 2.97, 95%CI: 1.77-5.00; OR = 2.62, 95%CI: 1.54-4.47) progression-free survival (PFS) rate, 12-month (OR = 2.34, 95%CI: 1.53-3.58; OR = 3.64, 95%CI: 2.65-5.01) and 18-month (OR = 2.27, 95%CI: 1.48-3.48; OR = 3.23, 95%CI: 2.33-4.48) overall survival (OS) rate compared with TACE or lenvatinib alone. In addition, the experimental group could significantly reduce the expression levels of serum alpha-fetoprotein (AFP) (standard mean difference [SMD] = 1.22, 95%CI: 0.67-1.78) and vascular endothelial growth factor (VEGF) (SMD = 1.27, 95%CI: 0.87-1.67). In terms of adverse events of drugs, the incidence of grade & GE; 3 hypertension and elevated aspartate aminotransferase and alanine aminotransferase in the experimental group was higher than that in the control group (P < .05).Conclusion: Compared with TACE or lenvatinib alone, TACE plus lenvatinib has achieved remarkable efficacy in patients with advanced HCC, and the efficacy versus risk need to be carefully balanced in clinical application.