Efficacy of TACE in combination with sorafenib versus sorafenib or TACE alone for advanced hepatocellular carcinoma: A meta-analysis of randomized controlled trials (RCTs).

e16259 Background: Hepatocellular Carcinoma (HCC) is the sixth fastest-growing type of cancer globally and the fourth largest cause of death related to cancer. We aimed to compare the efficacy of three modes of treatment for advanced HCC: Transarterial Chemoembolization (TACE), Sorafenib, and their combination. Methods: We searched Embase, Medline, Clinicaltrials.gov, the Cochrane Library, and grey literature sites from inception to November 2024 for RCTs comparing TACE, Sorafenib, and their combination for managing advanced HCC. The risk of bias in included studies was assessed using the revised Cochrane “Risk of Bias” tool for RCTs. Revman 5.4 was used to analyze outcomes using the risk ratio (RR) as the effect measure for the dichotomous outcomes and the hazard ratio (HR) for the continuous outcomes, along with 95 percent confidence intervals (CI) for each effect measure. Results: Our meta-analysis included six RCTs with a total of 1703 patients. The combination therapy of TACE and Sorafenib was found to be similar to TACE alone in terms of Overall survival (OS) [HR 0.96; 95% CI: 0.75-1.23]; Progression-free survival (PFS) [HR 0.84; 95% CI: 0.55-1.28]; and Time to disease progression (TTP) [HR 0.81; 95% CI: 0.65-1.00]. When compared to Sorafenib alone, the combination therapy had a similar OS [HR 0.75; 95% CI: 0.48-1.18]. The combination therapy of TACE and Sorafenib significantly decreased the disease progression rate when compared to the TACE alone therapy [RR 0.83; 95% CI: 0.77-0.99] and sorafenib alone therapy [RR 0.58; 95% CI: 0.43-0.78]. The overall response rate (ORR) [RR 1.09; 95% CI: 0.94-1.27] and disease control rate (DCR) [RR 0.99; 95% CI: 0.90-1.09] were similar in both the combination group and TACE alone group. The combination therapy significantly increased the incidences of rash, diarrhea, and hand and foot skin reaction as compared to the TACE-only therapy. Conclusions: The combination therapy was similar to the TACE-only therapy in terms of OS, PFS, TTP, DCR, and ORR but it significantly decreased the disease progression rate in advanced HCC patients. More RCTs are needed to support or refute our findings.