Effectiveness and safety of transarterial chemoembolization combined with apatinib in hepatocellular carcinoma: A systematic review and proportional meta-analysis.

Abstract

e16199 Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-related mortality. Many patients present with advanced disease, limiting curative options. Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage HCC, and apatinib, a VEGFR-2 inhibitor, has shown antitumor activity in advanced disease. We evaluated the efficacy and safety of combining TACE with apatinib. Methods: A systematic review and proportional meta-analysis were conducted. Of 263 screened studies, 10 eligible randomized and retrospective studies were included. Primary outcomes were objective response rate (ORR), disease control rate (DCR), and progressive disease (PD). Safety outcomes included treatment-related adverse events. Pooled proportions were calculated using common- and random-effects models in R (version 4.4.3), with heterogeneity assessed using the χ² test. Results: TACE plus apatinib demonstrated meaningful clinical activity. Pooled ORR was 57% (common-effects; 95% CI, 0.53–0.61) and 56% (random-effects; 95% CI, 0.44–0.66), with a maximum reported ORR of 71% (95% CI, 0.62–0.79). Pooled DCR was 79% (common-effects; 95% CI, 0.75–0.82) and 82% (random-effects; 95% CI, 0.73–0.89), with a peak of 96% (95% CI, 0.85–0.99). PD rates were low at 16% (common-effects; 95% CI, 0.13–0.20) and 15% (random-effects; 95% CI, 0.10–0.23). These outcomes exceeded historical results reported for TACE monotherapy (ORR ~44%, DCR ~73%). Adverse events, including hand–foot syndrome, hypertension, fever, diarrhea, and proteinuria, were generally manageable. Conclusions: Combining TACE with apatinib improves tumor response and disease control compared with TACE alone in patients with HCC, with an acceptable safety profile. These findings support the combination as a promising treatment strategy and warrant further prospective evaluation.