Several developments have been seen in the treatment landscape for advanced hepatocellular carcinoma (HCC). However, a head-to-head comparison of the available agents has not been performed. This study aims to examine the comparative effectiveness of various systematic treatments in patients with advanced HCC.

This systematic review and network meta-analysis included 14 phase 3 trials evaluating different checkpoint inhibitors (CPIs), vascular endothelial growth factor inhibitors (VEGFis), or the combinations of the two in the refractory or first-line setting. The researchers used the random-effects model to pool the overall effect. The primary outcomes of the study were overall survival (OS) and progression-free survival (PFS).

Of the 14 included trials, 8 were in the first-line setting and included 6,290 patients aged 18-89 years. FIve trials were included in the second-line analysis included a total of 2,6533 patients aged 18-91 years. Network meta-analysis suggested that the atezolizumab-bevacizumab combination was superior compared with lenvatinib, sorafenib, and nivolumab in patients with HCC treated in the first-line setting. The findings further suggested that all the tested drugs had PFS benefits, but only regorafenib and cabozantinib had OS benefits.

The research concluded that the atezolizumab-bevacizumab combination was superior to other drugs and has been considered as the standard care for patients with HCC.