AUTHOR=Hui Fuhai , Xu Chang , Xu Xiangbo , Chen Jiangxia , Geng Hefeng , Yang Chao , Zhang Yingshi 

TITLE=What Is the Most Suitable Agent Combined With Apatinib for Transarterial Chemoembolization Treatment in Advanced Hepatocellular Carcinoma Patients? A Systematic Review and Network Meta-analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.887332

DOI=10.3389/fonc.2022.887332

ISSN=2234-943X

ABSTRACT=Purpose: Combined therapy with Transarterial Chemoembolization (TACE) and Apatinib is superior in  therapeutic effect compared with TACE alone in patients with hepatocellular carcinoma (HCC). To determine the most suitable agent combined with Apatinib for TACE treatment, we did a systematic review and network meta-analysis. 
Methods: Four electronic databases were searched from inception until November 2021. Randomized controlled trials (RCTs) and retrospective studies which combined therapy of TACE and Apatinib (TACE+A) compared with TACE alone were included. We performed random-effect pairwise and network meta-analyses to summarize the outcomes about efficacy and safety. The study was registered with PROSPERO, CRD4202022311650. 
Results: Forty-five original studies including 3876 patients were included. In terms of efficacy, we evaluated treatment response, 6 months-overall survival, 1 year-OS, 6 months-progression-free survival, 1 year-PFS, AFP, MMP9 and VEGF. Significant differences always appear in TACE agent subgroups of Adriamycin, Platinum and Fluorouracil from both pairwise and network meta-analysis. While Significant differences could also be found in apatinib dosage of 500mg/d and >500mg/d subgroups, and both RCT and retrospective study subgroups. From second time network analysis, compared with TACE alone, subgroups with TACE agents of oxaliplatin, cisplatin, pirarubicin, epirubicin and 5-fluorouracil ranked front. Besides, the safety of Adriamycin, Platinum and Fluorouracil subgroups is acceptable. 
Conclusions: In conclusion, the most suitable agents in TACE combined with Apatinib were Adriamycin+Platinum±Fluorouracil combination therapy.