Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma

ZHANG Rongrong; FU Yu; ZHAO Ruixia; FANG Yuxuan; WANG Jingwen; SHAO Mingyi

doi:10.6039/j.issn.1001-0408.2024.15.13

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Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma

更新时间：2024-08-11

- Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma
- ZHONGGUO YAOFANG Vol. 35, Issue 15, Pages: 1876-1881(2024)
- 作者机构：
  
  1.河南中医药大学第一附属医院消化科，郑州　450000
  2.河南中医药大学第一临床医学院，郑州　450046
  3.河南中医药大学第一附属医院科研部，郑州　450000
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.15.13
  CLC： R979.1
- Published：15 August 2024，
  
  Received：21 January 2024，
  
  Revised：19 June 2024，
- 稿件说明：
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张容容,符宇,赵瑞霞等.4种一线免疫联合治疗方案用于不可切除肝细胞癌的多准则决策分析 ^Δ[J].中国药房,2024,35(15):1876-1881.

ZHANG Rongrong,FU Yu,ZHAO Ruixia,et al.Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma[J].ZHONGGUO YAOFANG,2024,35(15):1876-1881.
张容容,符宇,赵瑞霞等.4种一线免疫联合治疗方案用于不可切除肝细胞癌的多准则决策分析 ^Δ[J].中国药房,2024,35(15):1876-1881. DOI： 10.6039/j.issn.1001-0408.2024.15.13.

ZHANG Rongrong,FU Yu,ZHAO Ruixia,et al.Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma[J].ZHONGGUO YAOFANG,2024,35(15):1876-1881. DOI： 10.6039/j.issn.1001-0408.2024.15.13.

摘要

目的

评估4种用于不可切除肝细胞癌的一线免疫联合治疗方案的综合价值，为明确不可切除肝细胞癌的最佳临床治疗决策提供参考。

方法

采用R4.2软件对4项文献进行网状Meta分析，得到4种联合治疗方案[阿替利珠单抗联合贝伐珠单抗（AB方案）、信迪利单抗联合贝伐珠单抗生物类似物（SB方案）、卡瑞利珠单抗联合阿帕替尼（CA方案）、度伐利尤单抗联合替西木单抗（DT方案）]疗效和安全性指标的效应值；结合疗效、安全性和经济性指标，应用多准则决策分析软件M-MACBETH建立价值树，同时计算4种治疗方案的综合价值总分，采用敏感性分析评价结果的稳健性。

结果

在延长中位总生存期方面，4种治疗方案的优势排序依次是SB、CA、AB、DT方案；在延长中位无进展生存期方面，优势排序依次是CA、SB、AB、DT方案；在安全性方面，优势排序依次是DT、AB、SB、CA方案；在经济性方面，优势排序依次是CA、SB、AB、DT方案。SB、CA、AB、DT方案的综合价值总分分别为67.11、57.77、52.53、42.59分。敏感性分析结果显示，4种治疗方案的综合价值排名结果较为稳定。

结论

4种用于不可切除肝细胞癌的一线免疫联合治疗方案中，SB方案为最优治疗方案，而后为CA、AB和DT方案。

Abstract

OBJECTIVE

To evaluate the comprehensive value of four first-line combination immunotherapy for unresectable hepatocellular carcinoma， and provide a reference for determining the optimal clinical treatment decision for unresectable hepatocellular carcinoma.

METHODS

R4.2 software was used for network meta-analysis to obtain the effect values of the efficacy and safety indicators of four combination therapies [atezolizumab combined with bevacizumab （AB）， sintilimab combined with bevacizumab biosimilars （SB）， camrelizumab combined with apatinib （CA）， durvalumab combined with tremelimumab （DT）]. Combined with the efficacy， safety and economic indicators， the categorical based evaluation technique （M-MACBETH） was used to establish the value tree. At the same time， the comprehensive value scores of four therapies were calculated， and sensitivity analysis was performed to evaluate the robustness.

RESULTS

In terms of prolonging median overall survival， the advantage order of the four therapies was ranked as SB， CA， AB and DT. In terms of extending median progression-free survival， the advantage order of the four therapies was CA， SB， AB and DT. In terms of safety， the order of advantages was DT， AB， SB and CA. In terms of economy， the order of advantages was CA， SB， AB and DT. The comprehensive scores of SB， CA， AB and DT were 67.11， 57.77， 52.53 and 42.59 points， respectively. The results of the sensitivity analysis showed that the ranking results of comprehensive value for four regimens were robust.

CONCLUSIONS

Among the four first-line immune combination therapies for unresectable hepatocellular carcinoma， SB is the optimal treatment regimen， followed by CA， AB and DT.

关键词

不可切除肝细胞癌免疫联合治疗多准则决策分析综合评价

Keywords

combination immunotherapymulti-criteria decision analysiscomprehensive evaluation

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