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Review
. 2023 Jan 26;15(3):766.
doi: 10.3390/cancers15030766.

Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews

Javier Bracchiglione  1   2   3 , Gerardo Rodríguez-Grijalva  1 , Carolina Requeijo  1 , Marilina Santero  1 , Josefina Salazar  1 , Karla Salas-Gama  3   4 , Adriana-Gabriela Meade  1 , Alba Antequera  1 , Ariadna Auladell-Rispau  1 , María Jesús Quintana  1   3   5 , Ivan Solà  1   3   5 , Gerard Urrútia  1   3   5 , Roberto Acosta-Dighero  2 , Xavier Bonfill Cosp  1   3   5
Affiliations
Review

Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews

Javier Bracchiglione et al. Cancers (Basel). .

Abstract

Background: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs.

Methods: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome.

Results: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55-0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79-0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87-1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28-1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed.

Conclusion: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making.

Keywords: antineoplastic agents; biliary tract neoplasms; biological therapy; immunotherapy; liver neoplasms; molecular-targeted therapy; review literature as topic.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the selection of studies.
Figure 2
Figure 2
Matrix of evidence. All the included SRs are listed in the columns. All the relevant primary studies (i.e., those reporting at least one outcome of interest for the studied interventions) are listed in the rows. ‘1’ represents a primary study included in a specific SR. ‘X’ represents chronological structural missingness, that is, a primary study that cannot possibly be included in a SR, given that its publication date was more recent than the search date of the SR.
Figure 3
Figure 3
‘Graphical representation of overlap’ (GROOVE) assessment for each possible pair of SRs. For purposes of pairwise analysis of CCA, we did not consider structural missingness.
Figure 4
Figure 4
Forest plots for the outcomes ‘overall survival’ (a) and ‘toxicity’ (b) for the comparison of SOTs versus placebo/UPSC as first-line therapy in patients with advanced HCC.
Figure 4
Figure 4
Forest plots for the outcomes ‘overall survival’ (a) and ‘toxicity’ (b) for the comparison of SOTs versus placebo/UPSC as first-line therapy in patients with advanced HCC.
Figure 5
Figure 5
Forest plots for the outcomes ‘overall survival’ (a), ‘progression-free survival’ (b) and ‘toxicity’ (c) for the comparison of SOTs versus placebo/UPSC as second-line therapy or more in patients with advanced HCC.
Figure 6
Figure 6
Forest plot for the outcome ‘overall survival’ for the comparison of chemotherapy versus placebo/UPSC in patients with advanced gallbladder cancer.
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