In unresectable HCC, which new targeted therapy is best?

  • Ding W & al.
  • PLoS One
  • 1 Jan 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A network meta-analysis suggests that the kinase inhibitor vandetanib may be the best substitution for sorafenib with respect to OS in unresectable hepatocellular carcinoma (HCC), although the quality of evidence was low.

Why this matters

  • The newer drugs have been tested against sorafenib, but not each other.

Study design

  • Network analysis of 22 studies (N=9288).
  • Funding: Changzhou Municipal Wujin District.      

Key results

  • Time to progress (TTP; 17 trials): brivanib, lenvatinib, linifanib, and sorafenib conferred a significant improvement over placebo (HR range, 0.45-0.72).
  • A surface under the cumulative ranking curve (SUCRA) analysis showed the strongest effects associated with lenvatinib (HR, 0.94), linifanib (HR, 0.84), and brivanib (HR, 0.67).
  • Compared with lenvatinib, TTP was better with sunitinib (HR, 1.99) and nintedanib (HR, 2.17).
  • Compared with placebo, OS (20 trials) was better with vandetanib (HR, 0.44) and sorafenib (HR, 0.72).
  • There was no difference between the drugs with respect to PFS (8 trials), objective response rate (13 trials), or grade 3-5 adverse events (11 trials).

Limitations

  • The Barcelona Clinic Liver Cancer score distributions varied between the included trials.
  • Some HRs were extracted from survival curves rather than directly from the original articles.