阿替利珠联合贝伐珠治疗晚期肝癌的安全性及有效性的荟萃分析

Meta-Analysis of Safety and Efficacy of Atezolizumab plus Bevacizumab in Advanced Hepatocelluar Carcinoma

摘要: 目的：阿替利珠单抗(atezolizumab)联合贝伐珠单抗(bevacizumab)于2020年被中国国家药品监督管理局批准作为晚期肝细胞癌(HCC)的一线治疗药物。但各随机对照试验(RCT)及回顾性研究报道的两药安全性及有效性不尽相同，本研究的目的是进一步评估两者联合治疗晚期HCC的有效性及安全性。方法：在Web of Science、PubMed、Embase、Cochrane、CBM、知网、万方、维普各数据库检索了2018年1月1日至2023年10月1日关于阿替利珠单抗联合贝伐单抗来治疗晚期HCC的合格文献。结果包括总缓解率(OR)、完全缓解率(CR)、部分缓解率(PR)、中位总生存期(mOS)、中位无进展生存期(mPFS)和不良事件(AE)。结果：纳入了42项研究，包括3168名患者。基于实体瘤反应评价标准(RECIST)的长期(超过6周)治疗反应的OR、CR和PR分别为26%、3%和23%。合并的总生存期为12.2个月，合并中位无进展生存期为6.9个月。在治疗期间，63%的患者发生了不良事件，其中3级及以上的不良事件的发生率为42%。结论：阿替利珠单抗联合贝伐单抗治疗晚期HCC有效性和安全性良好。阿替利珠单抗联合贝伐单抗在晚期HCC的长期、一线和标准剂量治疗中显示出较好的肿瘤缓解率。

Abstract: Objective: Atezolizumab in combination with bevacizumab was approved by the National Medical Products Administration of China in 2020 as the first-line treatment for advanced hepatocellular carcinoma (HCC). However, the safety and efficacy reported varied between randomized controlled trials (RCT) and retrospective studies. The purpose of this study was to further evaluate the efficacy and safety of the combination in the treatment of advanced HCC. Method: The databases of Web of Science, PubMed, Embase, Cochrane, CBM, CNKI, Wanfang, and Virpup for the combination of bevacizumab and bevacizumab for advanced HCC were searched from January 1, 2018 to October 1, 2023. The results included the overall response rate (OR), complete response rate (CR), partial response rate (PR), median overall survival (mOS), median progression-free survival (mPFS), and adverse events (AEs). Results: 42 studies were included, including 3168 patients. The OR, CR, and PR for long-term treatment response (over 6 weeks) based on the response evaluation criteria (RECIST) for solid tumors were 26%, 3%, and 23%, respectively. The combined overall survival was 12.2 months, and the combined median progression-free survival was 6.9 months. During the treatment period, 63% of the patients had adverse events, with the incidence of grade 3 and above being 42%. Conclusion: Atezolizumab combined with bevacizumab in advanced HCC. Altelibizumab combined with bevacizumab showed better tumor response rates in long-term, first-line and standard dose therapy for advanced HCC.