HAIC combined with TKI and PD-1 inhibitor improves overall survival in unresectable hepatocellular carcinomaTriple therapy improves survival for patients with liver cancer

BackgroundThe triplet combination of hepatic arterial infusion chemotherapy (HAIC), a tyrosine kinase inhibitor (TKI), and a programmed cell death-1 (PD-1) inhibitor has emerged as a highly promising strategy for unresectable hepatocellular carcinoma (uHCC). This study aimed to comprehensively evaluate the efficacy and safety of this triple-therapy compared with the dual-therapy of a TKI plus a PD-1 inhibitor.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials or comparative cohort studies that assessed HAIC plus a TKI and a PD-1 inhibitor (H-T-P) versus a TKI plus a PD-1 inhibitor (T-P) for uHCC. The primary endpoints were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). The secondary endpoint was treatment-related adverse events (AEs). A random-effects model was employed to pool data, calculating hazard ratios (HRs) or relative risks (RRs) with their 95% confidence intervals (CIs).ResultsA total of 12 studies involving 2,386 patients with uHCC were included. Compared with T-P dual therapy, the H-T-P triple therapy was associated with significantly improved OS (HR, 0.51; 95%CI, 0.47-0.56; P