Survival in unresectable hepatocellular carcinoma: Comparison of four treatments based on patients reconstructed from Kaplan–Meier curves of randomized trials

doi:10.4292/wjgpt.120377

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World Journal of Gastrointestinal Pharmacology and Therapeutics

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2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Sep 5, 2026; 17(3): 120377
Published online Sep 5, 2026. doi: 10.4292/wjgpt.120377

Survival in unresectable hepatocellular carcinoma: Comparison of four treatments based on patients reconstructed from Kaplan–Meier curves of randomized trials

Vera Damuzzo, Stefano Vecchia, Lorenzo Gasperoni, Luna Del Bono, Andrea Ossato, Elena Orlandi, Andrea Messori

Vera Damuzzo, Department of Pharmacy, Vittorio Veneto Hospital, AULSS2 Marca Trevigiana, Vittorio Veneto 31029, Italy

Stefano Vecchia, Department of Pharmacy, AUSL Piacenza Guglielmo da Saliceto Hospital, Piacenza 29121, Italy

Lorenzo Gasperoni, Department of Pharmaceutical, USL Toscana Centro, Prato 59100, Italy

Luna Del Bono, Department of Pharmacy, University of Pisa, Pisa 56126, Italy

Andrea Ossato, UOC Territorial Pharmaceutical Service, Azienda ULSS 8 Berica, Vicenza 36100, Italy

Elena Orlandi, Department of Oncology-Haematology, Piacenza General Hospital, Piacenza 29191, Italy

Andrea Messori, Osservatorio Innovazione Section, HTA Regione Toscana, Firenze 50139, Italy

Co-first authors: Vera Damuzzo and Stefano Vecchia.

Author contributions: Damuzzo V and Vecchia S contributed to conceptualization, data curation, formal analysis, investigation, methodology, software, supervision, validation, writing-original draft, writing-review and editing, both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Gasperoni L, Del Bono L, Ossato A, Orlandi E, Messori A contributed to conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, writing-original draft, writing-review and editing.

AI contribution statement: AI tools (specifically ChatGPT) 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-generated outputs were critically reviewed and revised by the authors.

Conflict-of-interest statement: The authors declare no conflict of interests.

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: Andrea Messori, PharmD, Osservatorio Innovazione Section, HTA Regione Toscana, Via Alderotti 26/N, Firenze 50139, Italy. andrea.messori@osservatorioinnovazione.net

Received: February 27, 2026
Revised: April 30, 2026
Accepted: May 22, 2026
Published online: September 5, 2026
Processing time: 184 Days and 9.6 Hours

Core Tip

Core Tip: In the absence of head-to-head trials for first-line unresectable hepatocellular carcinoma, we reconstructed individual patient data from eight phase III trials to indirectly compare immune checkpoint inhibitor and tyrosine kinase inhibitor combinations. Most regimens outperformed sorafenib, with camrelizumab plus rivoceranib emerging as the most effective option, demonstrating superiority over tremelimumab plus durvalumab and anlotinib plus penpulimab. Restricted mean survival time analyses revealed that nivolumab plus ipilimumab, lenvatinib, and pembrolizumab plus lenvatinib achieved results similar to those of camrelizumab plus rivoceranib. These findings provide a practical framework for treatment positioning and underscore the critical influence of comparator on estimated efficacy.