The impact of curative conversion therapy aimed at a cancer-free state in patients with hepatocellular carcinoma treated with atezolizumab plus bevacizumab.
atezolizumab plus bevacizumab
conversion therapy
hepatocellular carcinoma
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
16
03
2023
received:
15
02
2023
accepted:
30
03
2023
medline:
20
6
2023
pubmed:
17
4
2023
entrez:
16
4
2023
Statut:
ppublish
Résumé
We aimed to validate the predictive factors for tumor response and the prognostic impact of conversion therapy aimed at cancer- and drug-free states in patients with unresectable hepatocellular carcinoma (u-HCC) undergoing atezolizumab plus bevacizumab (Atez/Bev) therapy. This retrospective study enrolled 156 patients who were Child-Pugh class A with u-HCC treated using Atez/Beva. The profile of objective response was investigated using decision-tree analysis. Progression-free, recurrence-free, and overall survival were assessed. The progression-free and overall survival were 6.1 and 18.0 months, respectively. Objective response and disease control rates were 32.0% and 84.0%, respectively. Decision-tree analysis revealed that neutrophil-to-lymphocyte ratio (NLR) <3, modified albumin-bilirubin grade (m-ALBI) 1 or 2a, and age < 75 were sequential splitting variables for the objective response, respectively. In the multivariate analysis, NLR <3 and m-ALBI grade 1 or 2a were identified as predictive factors for objective response. We successfully achieved eligibility for conversion therapy in 17 patients after Atez/Bev therapy significant response. Following conversion therapy, the curative therapy group, including surgical resection or radiofrequency ablation (RFA), had significantly higher recurrence-free survival than did the transcatheter arterial chemoembolization (TACE) and Atez/Bev discontinuation (surgical resection or RFA; not reached vs. TACE; 5.3 months, p = 0.008, Atez/Bev discontinuation; 3.9 months, p = 0.048, respectively) groups. NLR <3 and m-ALBI grade 1 or 2a were predictive factors for conversion therapy, leading to cancer- and drug-free states in patients with u-HCC undergoing Atez/Bev therapy. Moreover, surgery or RFA may be suitable for conversion therapy for cancer-free status.
Sections du résumé
BACKGROUND AND AIMS
We aimed to validate the predictive factors for tumor response and the prognostic impact of conversion therapy aimed at cancer- and drug-free states in patients with unresectable hepatocellular carcinoma (u-HCC) undergoing atezolizumab plus bevacizumab (Atez/Bev) therapy.
METHODS
This retrospective study enrolled 156 patients who were Child-Pugh class A with u-HCC treated using Atez/Beva. The profile of objective response was investigated using decision-tree analysis. Progression-free, recurrence-free, and overall survival were assessed.
RESULTS
The progression-free and overall survival were 6.1 and 18.0 months, respectively. Objective response and disease control rates were 32.0% and 84.0%, respectively. Decision-tree analysis revealed that neutrophil-to-lymphocyte ratio (NLR) <3, modified albumin-bilirubin grade (m-ALBI) 1 or 2a, and age < 75 were sequential splitting variables for the objective response, respectively. In the multivariate analysis, NLR <3 and m-ALBI grade 1 or 2a were identified as predictive factors for objective response. We successfully achieved eligibility for conversion therapy in 17 patients after Atez/Bev therapy significant response. Following conversion therapy, the curative therapy group, including surgical resection or radiofrequency ablation (RFA), had significantly higher recurrence-free survival than did the transcatheter arterial chemoembolization (TACE) and Atez/Bev discontinuation (surgical resection or RFA; not reached vs. TACE; 5.3 months, p = 0.008, Atez/Bev discontinuation; 3.9 months, p = 0.048, respectively) groups.
CONCLUSIONS
NLR <3 and m-ALBI grade 1 or 2a were predictive factors for conversion therapy, leading to cancer- and drug-free states in patients with u-HCC undergoing Atez/Bev therapy. Moreover, surgery or RFA may be suitable for conversion therapy for cancer-free status.
Identifiants
pubmed: 37062077
doi: 10.1002/cam4.5931
pmc: PMC10278513
doi:
Substances chimiques
atezolizumab
52CMI0WC3Y
Bevacizumab
2S9ZZM9Q9V
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
12325-12335Informations de copyright
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Hepatol Res. 2022 Mar;52(3):269-280
pubmed: 34761470
Eur J Surg Oncol. 2021 Aug;47(8):2038-2045
pubmed: 33640172
CA Cancer J Clin. 2021 May;71(3):209-249
pubmed: 33538338
N Engl J Med. 2018 Jul 05;379(1):54-63
pubmed: 29972759
N Engl J Med. 2020 May 14;382(20):1894-1905
pubmed: 32402160
Nat Rev Clin Oncol. 2022 Mar;19(3):151-172
pubmed: 34764464
Eur J Gastroenterol Hepatol. 2022 Jun 1;34(6):698-706
pubmed: 35170529
J Oncol Pract. 2016 Jan;12(1):33-9
pubmed: 26759464
Cancer Med. 2023 Jun;12(11):12325-12335
pubmed: 37062077
Target Oncol. 2022 Nov;17(6):643-653
pubmed: 36272060
N Engl J Med. 2008 Jul 24;359(4):378-90
pubmed: 18650514
Lancet Oncol. 2019 Feb;20(2):282-296
pubmed: 30665869
Ann Surg Oncol. 2007 Dec;14(12):3301-9
pubmed: 17891443
Eur J Cancer. 2009 Jan;45(2):228-47
pubmed: 19097774
Hepatol Commun. 2020 Jun 20;4(8):1218-1228
pubmed: 32766480
Invest New Drugs. 2020 Feb;38(1):172-180
pubmed: 31172442
J Hepatol. 2022 Apr;76(4):862-873
pubmed: 34902530
Hepatol Res. 2019 Aug;49(8):919-928
pubmed: 30969006
Hepatol Res. 2022 May;52(5):462-470
pubmed: 35080087
J Immunol. 1986 Jun 15;136(12):4460-3
pubmed: 3486900
Liver Cancer. 2021 Jul;10(4):320-329
pubmed: 34414120
Front Oncol. 2021 Nov 18;11:772195
pubmed: 34869008
Oncology. 2023;101(4):270-282
pubmed: 36455517
Cancers (Basel). 2021 Oct 30;13(21):
pubmed: 34771637
Chirurg. 2001 May;72(5):547-60
pubmed: 11383067
Hepatology. 2008 Jan;47(1):97-104
pubmed: 18069697
World J Surg. 2016 Aug;40(8):1951-8
pubmed: 27220509
Ann Hepatol. 2021 May-Jun;22:100249
pubmed: 32896610
Exp Mol Med. 2020 Dec;52(12):1898-1907
pubmed: 33268834
Liver Cancer. 2021 Feb;10(1):1-9
pubmed: 33708635
Lancet. 2018 Mar 24;391(10126):1163-1173
pubmed: 29433850
Actas Dermosifiliogr (Engl Ed). 2021 Jan;112(1):90-92
pubmed: 32891586
J Hepatocell Carcinoma. 2019 Feb 05;6:49-69
pubmed: 30788336
Cancer Med. 2023 Mar;12(6):6980-6993
pubmed: 36484470
JAMA Oncol. 2023 Apr 1;9(4):527-535
pubmed: 36795388
Hepatology. 2015 Jan;61(1):191-9
pubmed: 25142309
Cancers (Basel). 2020 Jul 03;12(7):
pubmed: 32635230
Sci Rep. 2022 Oct 11;12(1):17018
pubmed: 36220865
Invest New Drugs. 2022 Apr;40(2):392-402
pubmed: 34586531
Korean J Hepatol. 2008 Sep;14(3):371-80
pubmed: 18815460
Hepatol Res. 2023 May;53(5):383-390
pubmed: 36826411
Hepatol Res. 2023 Jan;53(1):61-71
pubmed: 36070216
Ann Transplant. 2021 May 11;26:e930383
pubmed: 33972494
Ann Surg Oncol. 2023 May;30(5):2782-2790
pubmed: 36178565