SynthesisBMC cancer2026
Efficacy and safety of immune-based combinations in metastatic hepatocellular carcinoma: a systematic review and network meta-analysis.
Synthesis in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundImmune checkpoint inhibitors (ICIs) combined with other agents have emerged as the standard first-line treatment for metastatic hepatocellular carcinoma (HCC), replacing tyrosine kinase inhibitors (TKIs). However, the comparative efficacy and safety of different ICI-based combinations remains unclear.
objectiveTo evaluate the efficacy and safety of ICI-based combinations versus TKIs across different regimens through a systematic review and network meta-analysis (NMA) of phase III randomized controlled trials (RCTs).
methodsA comprehensive literature search was conducted across major databases and conference proceedings between 2019 and 2024. Eligible studies included phase III RCTs that evaluated ICI combinations in the first-line setting for metastatic HCC. Pairwise meta-analysis and Bayesian NMA were performed to assess overall survival (OS), progression-free survival (PFS), overall response rate (ORR), treatment-related adverse events (TRAEs), grade 3–4 TRAEs, and therapy discontinuation owing to toxicity.
resultsSix RCTs comprising 3937 patients were included in the study. Compared with TKIs, ICI-based combinations improved OS (OR, 0.72; 95% CI: 0.58–0.91) and ORR (OR: 3.13; 95% CI: 2.07–4.47), without significantly increasing TRAEs. No significant benefit was observed in PFS (OR, 0.81; 95% CI: 0.56–1.19). The NMA rankings suggested camrelizumab plus rivaroceranib (CAM+ RIVO), nivolumab plus ipilimumab (NIVO + IPI), and durvalumab plus remelimumab (DURVA + TREME) as the most effective regimens for OS, PFS, and ORR, respectively. DURVA + TREME appeared to have the best safety profile, and CAM + RIVO was associated with higher rates of treatment discontinuation due to toxicity.
conclusionICI-based combinations are more effective than TKIs in improving the OS and ORR in patients with metastatic HCC, with an acceptable safety profile. CAM + RIVO, NIVO + IPI, and DURVA + TREME have emerged as promising first-line options, although direct comparisons in future trials are warranted to confirm these findings.
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