1010P - A parametric network meta-analysis of first-line systemic therapies for advanced hepatocellular carcinoma related to overall survival

Background

Advanced hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Several first-line systemic therapies have been developed to treat advanced HCC, but their comparative effectiveness remains unclear. This study aimed to conduct a parametric network meta-analysis of first-line systemic therapies for advanced HCC related to overall survival.

Methods

We conducted a systematic literature review of randomized controlled trials assessing first-line systemic therapies for treating adults with locally advanced or metastatic unresectable HCC. The data sources included biomedical databases (Embase, MEDLINE, and CENTRAL), relevant conferences, and grey literature searches. We used the Bayesian framework to perform the analysis, and the distribution of the survival data was modeled using five different parametric distributions. We used deviance information criteria (DIC) to evaluate the goodness of fit of each model. The proportional hazards (PH) assumption was also tested.

Results

The parametric network meta-analysis included 9 randomized controlled trials involving 10 treatments. The log-normal distribution provided the best fit to the survival data, with a DIC value of 3558.4. At 12 months, the highest overall survival rate was seen in the Durvalumab group, with 43% of patients still alive. This was followed by Atezolizumab + bevacizumab, STRIDE, Nivolumab, Donafenib, and sintilimab plus IBI30. The lowest overall survival rates were seen in the Placebo group (17%) and Sorafenib group (28%). At 60 months, the overall survival rate was salmost same among the active treatments.

Conclusions

Parametric NMA is the most preferred method in case of violation of the proportional hazard assumption. Durvalumab and atezolizumab plus bevacizumab were the most effective first-line systemic therapies for advanced HCC in terms of overall survival. These findings can inform treatment decisions for patients with advanced HCC. However, additional studies are needed to confirm these findings and to evaluate the long-term efficacy and safety of these treatments.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.