Assessing comparative efficacies of camrelizumab as a single or combination therapy in patients with hepatocellular carcinoma: A systematic review and network meta-analysis.

Abstract

e16284 Background: Hepatocellular carcinoma (HCC) is associated with frequent recurrences and relapse. Camrelizumab (CAM), an anti-PD-1 immune checkpoint inhibitor, is known to convert “cold” tumors to “hot”, allowing immune system activation. In this systematic review and network meta-analysis, we aim to compare CAM monotherapy with its combinations with other agents like Lenvatinib (LEN), Sorafenib (SOR), Rivoceranib (RIV), other tyrosine kinase inhibitors (TKI), hepatic arterial infusion chemotherapy (HAIC), and trans arterial chemoembolization (TACE). Methods: Literature search was conducted across 5 databases to identify original studies evaluating the use of CAM as a mono- or combination therapy in patients diagnosed with HCC. Data was quantified as either odds ratio (OR) or hazard ratio (HR). Data analysis was conducted in netmeta employing a common-effects model, with the common comparator being CAM. Results: A total of 25 studies comprising a population of 5,062 patients were included for quantitative analysis. Among all treatment arms, CAM+LEN was associated with the highest overall survival (HR: 1.46 [1.25, 1.7], p < 0.0001) and progression-free survival (HR: 1.63 [1.41, 1.89], p < 0.0001), followed by CAM+RIV+HAIC, and CAM+TKI. The highest disease control rate was achieved with the use of CAM+TACE (OR: 56.47 [3.03, 1053.1], p = 0.007), followed by CAM+TACE+LEN, and TACE+LEN. Similar trends were observed for objective response rates as well. However, monotherapy with TACE was associated with the highest mortality (OR: 557.4 [24.48, 12691.11], p < 0.0001), followed by TACE+LEN and CAM+TACE. While assessing individual adverse events, incidence of nausea was highest with TACE based chemotherapies, including CAM+TACE, CAM+TACE+LEN, CAM+TACE+TKI; however, significantly lower odds of developing diarrhea was observed on use of CAM +LEN (OR: 0.23 [0.07, 0.72], p = 0.03). Patients treated with CAM+TACE+TKI had the highest incidence of diarrhea (OR: 1.43 [0.47, 4.35), p = 0.03). Incidence of anemia significantly decreased over CAM monotherapy on use of CAM+RIV (OR: 0.09 [0.02, 0.4], p = 0.001), followed by CAM+RIV+HAIC (OR: 0.14 [0.03, 0.63], p = 0.01) and CAM+SOR. Conclusions: LEN-based combinations offered the highest survival benefits, suggesting a synergistic action in reducing tumor burden. While TACE based regimens offered the highest immediate response and control rate, these therapies were associated with a significantly higher risk of chemotherapy-associated adverse events. Combination therapies with LEN or RIV significantly reduced the risk of adverse events, implying a safer profile. Further studies are needed to assess the superiority of each combination therapies over a longer follow-up period.