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Tyrosine kinase inhibitors after progression on atezolizumab-bevacizumab in advanced hepatocellular carcinoma: A systematic review and meta-analysis
Ronald Blanco Montecino, Daniel Mendoza-Quispe, Department of Internal Medicine, Saint Barnabas Hospital, CUNY School of Medicine, Bronx, NY 10457, United States
Nehemias Guevara Rodriguez, John M Richart, Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Internal Medicine, SSM Health Saint Louis University Hospital, Saint Louis University School of Medicine, St. Louis, MO 63110, United States
Noemy Coreas, Department of Gynecologic Oncology, Salvadoran Social Security Institute, University of El Salvado, San Salvador 1101, El Salvador
Yassine Kilani, Division of General Internal Medicine, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63110, United States
Syeda Ashna Fatima Kamal, Department of Medicine, Washington University in Saint Louis, St. Louis, MO 63110, United States
Kamran Qureshi, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO 63110, United States
Co-corresponding authors: Ronald Blanco Montecino and Nehemias Guevara Rodriguez.
Author contributions: Blanco Montecino R contributed to the conception and design of the study, conducted literature screening and data extraction, and led the drafting and final revision of the manuscript; Guevara Rodriguez N contributed to study design, conducted literature screening and data extraction, and performed critical revision of the manuscript; Coreas N contributed to data collection and manuscript drafting; Mendoza-Quispe D contributed to statistical design, data analysis, and resolved disagreements during study selection; Kilani Y and Kamal SAF contributed to data interpretation, methodological input, and critical revision of the manuscript; Qureshi K and Richart JM contributed to critical revision of the manuscript and overall supervision; Blanco Montecino R and Guevara Rodriguez N contributed equally to this manuscript and are co-corresponding authors. All authors have read and approved the final manuscript.
AI contribution statement: AI tools (specifically Grammarly) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-assisted outputs were critically reviewed and revised by the authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Ronald Blanco Montecino, MD, Department of Internal Medicine, Saint Barnabas Hospital, CUNY School of Medicine, 4422 Third Avenue, Bronx, NY 10457, United States. ronaldmau94@gmail.com
Received: March 30, 2026
Revised: May 3, 2026
Accepted: May 27, 2026
Published online: June 27, 2026
Processing time: 84 Days and 16.9 Hours
Revised: May 3, 2026
Accepted: May 27, 2026
Published online: June 27, 2026
Processing time: 84 Days and 16.9 Hours
Core Tip
Core Tip: Atezolizumab plus bevacizumab represents the standard first-line therapy for advanced hepatocellular carcinoma; however, treatment options after disease progression remain poorly defined. Tyrosine kinase inhibitors, established prior to the immunotherapy era, are frequently used in this setting, although their effectiveness after prior immunotherapy exposure is not well characterized. Therefore, a comprehensive evaluation of their role is needed. Our meta-analysis assessed the efficacy and safety of tyrosine kinase inhibitors after progression on atezolizumab plus bevacizumab in advanced hepatocellular carcinoma.