Evaluation on Efficacy and Safety of Arsenic Trioxide Plus Transcatheter Arterial Chemoembolization Versus Transcatheter Arterial Chemoembolization alone for Unresectable Primary Liver Cancer

Currently, some clinical trials of arsenic trioxide (As203) plus transcatheter arterial chemoembolization (TACE) in the treatment of unresectable primary liver cancer (PLC) had been conducted, but the results were controversial. Therefore, we performed a meta-analysis on 14 clinical trials (1076 cases) to evaluate efficacy and safety of As203 plus TACE versus TACE alone for unresectable PLC. The primary end points included objective response rate (ORR), karnofsky performance score (KPS) improvement rate, and 1-year survival rate. The second end points were adverse events consisting of leukopenia, liver dysfunction, nausea/vomiting, fever, myelosuppression and pain. Our study showed that, compared with TACE alone, As203 plus TACE appeared a significant benefit on ORR (RR = 1.32, 95% CI: 1.15,1.50, P < 0.0001), KPS improvement rate (RR = 1.24, 95% CI: 1.03,1.48, P = 0.02) and 1-year survival rate (RR = 1.31, 95% CI: 1.15,1.49, P < 0.0001). Additionally, no remarkable difference of adverse events were observed between two arms: leukopenia (RR = 1.44, 95% CI: 0.90,2.32, P = 0.13), liver dysfunction (RR = 0.96, 95% CI: 0.76,1.21, P = 0.71), nausea/vomiting (RR = 1.10, 95% CI: 0.84,1.44, P = 0.48), fever (RR = 1.15, 95% CI: 0.82,1.61, P = 0.43), myelosuppression (RR = 1.07, 95% CI: 0.74,1.56, P = 0.72) and pain (RR = 0.88, 95% CI: 0.57,1.36, P = 0.57). This study demonstrated that As203 plus TACE produced a favorable efficacy without enhancing adverse events and was a promising combination therapy option for unresectable PLC.