Immunotherapy vs Best Supportive Care for Patients With Hepatocellular Cancer With Child-Pugh B Dysfunction

TY - JOUR

T1 - Immunotherapy vs Best Supportive Care for Patients With Hepatocellular Cancer With Child-Pugh B Dysfunction

AU - Fulgenzi, Claudia Angela Maria

AU - Scheiner, Bernhard

AU - D'Alessio, Antonio

AU - Mehan, Aman

AU - Manfredi, Giulia F

AU - Celsa, Ciro

AU - Nishida, Naoshi

AU - Ang, Celina

AU - Marron, Thomas U

AU - Wu, Linda

AU - Saeed, Anwaar

AU - Wietharn, Brooke

AU - Cammarota, Antonella

AU - Pressiani, Tiziana

AU - Pinter, Matthias

AU - Sharma, Rohini

AU - Cheon, Jaekyung

AU - Huang, Yi-Hsiang

AU - Lee, Pei-Chang

AU - Phen, Samuel

AU - Gampa, Anuhya

AU - Pillai, Anjana

AU - Napolitano, Andrea

AU - Vivaldi, Caterina

AU - Salani, Francesca

AU - Masi, Gianluca

AU - Silletta, Marianna

AU - Lo Prinzi, Federica

AU - Di Giacomo, Emanuela

AU - Vincenzi, Bruno

AU - Bettinger, Dominik

AU - Thimme, Robert

AU - Vogel, Arndt

AU - Schönlein, Martin

AU - von Felden, Johann

AU - Schulze, Kornelius

AU - Wege, Henning

AU - Galle, Peter R

AU - Pirisi, Mario

AU - Park, Joong-Won

AU - Kudo, Masatoshi

AU - Rimassa, Lorenza

AU - Singal, Amit G

AU - El Tomb, Paul

AU - Ulahannan, Susanna

AU - Parisi, Alessandro

AU - Chon, Hong Jae

AU - Hsu, Wei-Fan

AU - Ghittoni, Giorgia

AU - Cammà, Calogero

AU - Stefanini, Benedetta

AU - Trevisani, Franco

AU - Giannini, Edoardo G

AU - Cortellini, Alessio

AU - Pinato, David James

PY - 2024/9/1

Y1 - 2024/9/1

N2 - IMPORTANCE: Whether patients with Child-Pugh class B (CP-B) cancer with unresectable hepatocellular carcinoma (uHCC) benefit from active anticancer treatment vs best supportive care (BSC) is debated.OBJECTIVE: To evaluate the association of immune checkpoint inhibitor (ICI)-based therapies vs BSC with overall survival (OS) of patients with uHCC and CP-B liver dysfunction.DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter, international clinical case series examined data of patients with CP-B with uHCC who were receiving first-line ICI-based regimens from September 2017 to December 2022 whose data were extracted from an international consortium and compared with a cohort of patients with CP-B receiving BSC. Patients were treated in tertiary care centers across Europe, US, and Asia in routine clinical practice. After applying the inclusion criteria, 187 and 156 patients were left in the ICI and BSC groups, respectively. The propensity score was calculated for the following variables: age, alpha-fetoprotein levels, Child-Pugh score, extrahepatic spread, portal vein tumor thrombosis, cirrhosis, ascites, and baseline Eastern Cooperative Oncology Group performance status.EXPOSURES: Patients in the ICI group received first-line systemic therapy with either atezolizumab plus bevacizumab (A+B) (n = 141) or nivolumab (n = 46).MAIN OUTCOMES AND MEASURES: OS in the inverse probability of treatment weighting (IPTW) populations was the main outcome, and it was estimated with Kaplan-Meier method; univariable Cox regression test was used to make comparisons between the 2 groups.RESULTS: The median age was 66 (IQR, 61-72) and 73 (IQR, 66-81) years in the ICI (33 women [18%]) and BSC groups (41 women [26%]), respectively. In the IPTW populations, median OS was significantly longer in the ICI group (7.50 months; 95% CI, 5.62-11.15) compared with BSC (4.04 months; 95% CI, 3.03-5.03; hazard ratio, 0.59; 95% CI, 0.43-0.80; P < .001). Multivariable analysis confirmed that ICI exposure was associated with a reduction of approximately 50% in the risk of death (hazard ratio, 0.55; 95% CI, 0.35-0.86; P < .001), and the presence of portal vein tumor thrombosis, an Eastern Cooperative Oncology Group performance score of greater than 1, and alpha-fetoprotein levels of 400 ng/mL or greater were associated with increased risk of death.CONCLUSIONS AND RELEVANCE: The results of this case series provide comparative evidence of improved survival in association with ICI treatment compared with BSC in patients with uHCC with CP-B liver dysfunction.

AB - IMPORTANCE: Whether patients with Child-Pugh class B (CP-B) cancer with unresectable hepatocellular carcinoma (uHCC) benefit from active anticancer treatment vs best supportive care (BSC) is debated.OBJECTIVE: To evaluate the association of immune checkpoint inhibitor (ICI)-based therapies vs BSC with overall survival (OS) of patients with uHCC and CP-B liver dysfunction.DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter, international clinical case series examined data of patients with CP-B with uHCC who were receiving first-line ICI-based regimens from September 2017 to December 2022 whose data were extracted from an international consortium and compared with a cohort of patients with CP-B receiving BSC. Patients were treated in tertiary care centers across Europe, US, and Asia in routine clinical practice. After applying the inclusion criteria, 187 and 156 patients were left in the ICI and BSC groups, respectively. The propensity score was calculated for the following variables: age, alpha-fetoprotein levels, Child-Pugh score, extrahepatic spread, portal vein tumor thrombosis, cirrhosis, ascites, and baseline Eastern Cooperative Oncology Group performance status.EXPOSURES: Patients in the ICI group received first-line systemic therapy with either atezolizumab plus bevacizumab (A+B) (n = 141) or nivolumab (n = 46).MAIN OUTCOMES AND MEASURES: OS in the inverse probability of treatment weighting (IPTW) populations was the main outcome, and it was estimated with Kaplan-Meier method; univariable Cox regression test was used to make comparisons between the 2 groups.RESULTS: The median age was 66 (IQR, 61-72) and 73 (IQR, 66-81) years in the ICI (33 women [18%]) and BSC groups (41 women [26%]), respectively. In the IPTW populations, median OS was significantly longer in the ICI group (7.50 months; 95% CI, 5.62-11.15) compared with BSC (4.04 months; 95% CI, 3.03-5.03; hazard ratio, 0.59; 95% CI, 0.43-0.80; P < .001). Multivariable analysis confirmed that ICI exposure was associated with a reduction of approximately 50% in the risk of death (hazard ratio, 0.55; 95% CI, 0.35-0.86; P < .001), and the presence of portal vein tumor thrombosis, an Eastern Cooperative Oncology Group performance score of greater than 1, and alpha-fetoprotein levels of 400 ng/mL or greater were associated with increased risk of death.CONCLUSIONS AND RELEVANCE: The results of this case series provide comparative evidence of improved survival in association with ICI treatment compared with BSC in patients with uHCC with CP-B liver dysfunction.

U2 - 10.1001/jamaoncol.2024.2166

DO - 10.1001/jamaoncol.2024.2166

M3 - SCORING: Journal article

C2 - 39023864

VL - 10

SP - 1253

EP - 1258

JO - JAMA ONCOL

JF - JAMA ONCOL

SN - 2374-2437

IS - 9

ER -