Efficacy of Camrelizumab and Apatinib Combination Therapy Versus Apatinib Only in Treatment of Advanced Hepatocellular Carcinoma: A Meta-Analysis.

e16147 Background: Recent studies have assessed the efficacy of some therapeutics in advanced hepatocellular carcinoma. Our aim is to perform a meta-analysis to compare the efficacy of Camrelizumab and Apatinib combination therapy versus Apatinib only in treatment of advanced hepatocellular carcinoma. Methods: We searched PubMed, WOS, Embase and Scopus databases. Inclusion criteria were clinical trials and cohort studies that evaluated the efficacy of Camrelizumab and Apatinib combination therapy or Apatinib only in treatment of advanced hepatocellular carcinoma. We excluded case reports, conference abstracts, editorials and animal studies. CMA software (version 3) was used to perform the meta-analysis. Continuous outcomes were presented as (mean and SD) and dichotomous outcomes as event ratio(ER), with 95% confidence interval (CI). Results: After complete screening, 12 studies were finally included in our study. 4 studies for combination of Camerlizumab and Apatinib while 8 studies investigated the role of Apatinib in patients with advanced hepatocellular carcinoma. The total number of patients included in the study is 844; 172 in combination group and 672 in Apatinib group. By indirect comparison, combination therapy is associated with a relatively better pooled survival rate (ER = 0.532, 95% CI [0.446, 0.615]) compared to Apatinib only therapy (ER = 0.262, 95% CI [0.218, 0.313]). Combination therapy was also associated with higher pooled rates of disease control (ER = 0.755, 95% CI [0.683, 0.815]) compared with Apatinib only (ER = 0.683, 95% CI [0.644, 0.720]). While the Combination therapy was associated with lower pooled rate of stable disease (ER = 0.13, 95% CI [0.339, 0.491]) than Apatinib (ER = 0.531, 95% CI [0.492, 0.570]). The overall survival time was significantly higher in combination therapy (Mean = 14.375, 95% CI [14.101, 14.649]) compared to the pooled mean survival time from Apatinib only therapy (Mean = 10.390, 95% CI [9.925, 10.855]). Conclusions: This study showed that Camrelizumab and Apatinib combination therapy is associated with increased survival rate, disease control and overall survival time in advanced hepatocellular carcinoma patients compared with Apatinib only. It revealed also that combination therapy is associated with lower stable disease than Apatinib only. Further multicenter clinical trials are needed to support our results.