Underlying liver disease does not affect HCC survival after immune checkpoint inhibition

January 25, 2022

2 minute read


WuYL, et al. Abstract 396. Presented at: ASCO Gastrointestinal Cancers Symposium; January 20-22, 2022; San Francisco.

Disclosures: Wu does not report any relevant financial information. Please see the summary for all relevant financial disclosures from other researchers.

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According to study results presented at the ASCO Symposium on Gastrointestinal Cancers, the benefit of immune checkpoint inhibitor therapy for hepatocellular carcinoma did not vary by underlying liver disease. underlying.

Patients with HCC of viral origin achieved numerically longer OS than those with disease of nonviral origin; however, the difference did not reach statistical significance.

Main results of the study.
Data derived from Wu YL, et al. Abstract 396. Presented at: ASCO Gastrointestinal Cancers Symposium; January 20-22, 2022; San Francisco.

“Further studies with increased granularity are needed to more clearly identify patients with unresectable HCC who are more likely to have better outcomes with immunotherapy,” the researcher said. Linda Wu, MD, fellow in hematology and medical oncology at Mount Sinai Hospital, Healio told.

Immune checkpoint inhibitors, alone or in combination with bevacizumab (Avastin, Genentech), have become standard treatment for patients with unresectable HCC. Although this class of agent has improved HCC outcomes, only a small percentage of patients respond to it.

“[This highlights] the need to identify biomarkers to improve patient selection,” Wu said. “Emerging evidence suggests that patients with nonviral causes of HCC, particularly nonalcoholic steatohepatitis (NASH), may not derive the same benefit of immunotherapy as those with viral causes.We hoped to use real-world data to assess whether patients with viral HCC had better survival outcomes when treated with immunotherapy compared to patients with HCC not viral.

Wu and colleagues performed a retrospective chart review of 349 patients (median age, 63 years; 84% male) with unresectable HCC treated with immune checkpoint inhibitors between January 2017 and June 2021 at Mount Sinai Health System. The researchers characterized the majority (86%) of the patients as cirrhotic.

Most patients (70%) had HCC of viral etiology, with two-thirds (67.5%) of these cases due to hepatitis C infection. Thirty percent of patients had non-viral causes of HCC, with the most common causes being NASH (47%) and alcohol (39%).

The majority of patients had Child-Pugh class A liver disease (66%) and an ECOG performance status of 0 (71%) at the time of immune checkpoint inhibitor initiation.

Most patients (79%) received immune checkpoint inhibitors as first-line treatment, and the majority (87%) received nivolumab (Opdivo, Bristol Myers Squibb).

The difference in OS between patients with viral etiologies and non-viral etiologies of HCC served as the primary outcome. These groups appeared balanced with respect to age, gender, cirrhosis, ECOG performance status, line of treatment, and type of immune checkpoint inhibitor received.

After a median follow-up of 10.5 months (range: 1.4-62.4), researchers reported longer median OS in patients with viral HCC (19.3 months; 95% CI, 14. 2-26.6) than in patients with nonviral HCC (11.4 months; 95% CI, 9.3-17.7). However, the difference – after adjusting for Child-Pugh class and disease stage – did not reach statistical significance (HR = 0.81; 95% CI, 0.58-1.12).

“The lack of statistical significance was somewhat surprising, as several studies have now shown this trend of improved survival in patients with viral HCC treated with immunotherapy,” Wu told Healio. “However, the study may have been underpowered.”

The result underscores the need to better define the subgroups of patients most likely to benefit from immunotherapy, Wu added.

“Although immunotherapy has revolutionized the treatment of advanced unresectable HCC, only about a third of patients respond, based on the IMbrave150 trial,” Wu said. to immunotherapy are important for optimizing patient selection, and we hope that matching patients with optimal therapy would also improve patient outcomes.”

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