Early Hepatic Decompensation Identifies Patients with Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab or Sorafenib at Highest Risk of Death

被引:1
|
作者
Cabibbo, Giuseppe [1 ]
Celsa, Ciro [1 ,2 ]
Battaglia, Salvatore [3 ]
Enea, Marco [4 ]
Di Maria, Gabriele [4 ]
Grova, Alessandro [1 ]
Ciccia, Roberta [1 ]
Manfredi, Giulia F. [2 ,5 ]
Iavarone, Massimo [6 ]
Vogel, Arndt [7 ,8 ]
Singal, Amit G. [9 ]
Reig, Maria [10 ,11 ,12 ,13 ]
Pinato, David J. [2 ,5 ]
Camma, Calogero [1 ]
机构
[1] Univ Palermo, Sect Gastroenterol & Hepatol, Dept Hlth Promot Mother & Child Care, Internal Med & Med Specialties PROMISE, Piazza delle Cliniche 2, I-90127 Palermo, Italy
[2] Imperial Coll London, Hammersmith Hosp, Dept Surg & Canc, London, England
[3] Univ Palermo, Dept Econ Business & Stat, Palermo, Italy
[4] Univ Palermo, Dept Hlth Promot Mother & Child Care, Internal Med & Med Specialties PROMISE, Palermo, Italy
[5] Univ Piemonte Orientale, Dept Translat Med, Novara, Italy
[6] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, Milan, Italy
[7] Hannover Med Sch, Hannover, Germany
[8] Univ Hlth Network, Schwartz Reisman Liver Res Ctr, Toronto Gen Hosp Res Inst, Schwartz Reisman Liver Res Ctr,Div Gastroenterol &, Toronto, ON, Canada
[9] Univ Texas SouthWestern Med Ctr, Dept Internal Med, Dallas, TX USA
[10] Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona Clin Liver Canc BCLC Grp, Barcelona 08036, Spain
[11] Hosp Clin Barcelona, Liver Oncol Unit, Liver Unit, Barcelona, Spain
[12] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
[13] Barcelona Univ, Barcelona, Spain
关键词
D O I
10.1158/1078-0432.CCR-24-2582
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The prognosis of patients with unresectable hepatocellular carcinoma (HCC) and compensated cirrhosis is influenced by cancer progression. Data on the incidence and the prognostic role of clinical hepatic decompensation (CHD) following immune checkpoint inhibitor therapy are lacking. We aimed to assess whether early CHD within 3 months from commencement of systemic therapy affects overall survival (OS) of patients treated with atezolizumab plus bevacizumab or sorafenib. Patients and Methods: Individual patient data from the IMbrave150 trial were analyzed. Cumulative incidence of CHD was assessed by competing risk analysis against HCC radiologic progression. Early CHD and HCC radiologic progression were assessed as predictors of OS by the time-dependent Cox model. Results: The 3- and 12-month rates of CHD were 7% and 12%, respectively, whereas the 3- and 12-month rates of HCC radiologic progression were 23% and 52%, respectively. Albumin-bilirubin grade 2 [subdistribution HR (sHR) = 1.79, 95% confidence interval (CI), 1.01-3.19; P = 0.049], INR (sHR = 1.97, 95% CI, 1.64-2.37; P < 0.001), and presence of neoplastic macrovascular invasion (sHR = 2.01, 95% CI, 1.14-3.54; P = 0.020) were independently associated with higher risk of CHD. Early CHD (HR = 7.56, 95% CI, 4.47-12.8) and early HCC radiologic progression (HR = 5.92, 95% CI, 4.03-8.69), as first events, were independently associated with higher mortality. Conclusions: This study provides robust evidence that early CHD is associated with the highest risk of death in patients with unresectable HCC undergoing systemic treatment. Within well-compensated participants, albumin-bilirubin, INR, and macrovascular invasion identify a population at higher risk of decompensation. Inclusion of clinical decompensation events in future prospective clinical trials may improve characterization of OS from systemic therapy of HCC.
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收藏
页码:543 / 550
页数:8
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