In a retrospective study reported in JAMA Oncology, Fulgenzi et al found evidence that immune checkpoint inhibitor (ICI)-based treatment may improve survival vs best supportive care as first-line therapy in patients with unresectable hepatocellular carcinoma and Child-Pugh class B (CP-B) liver dysfunction.
Study Details
The study involved data on patients with CP-B treated with ICI-based regimens between September 2017 and December 2022 from an international consortium and a cohort of patients treated with best supportive care; all patients were treated in tertiary care centers in Europe, the United States, and Asia in routine clinical practice. The main outcome measure was overall survival in the inverse probability of treatment weighting population.
Key Findings
A total of 187 patients who received ICI-based treatment and 156 who received best supportive care only were included in the analysis. Patients in the ICI group received atezolizumab plus bevacizumab (n = 141) or nivolumab (n = 46).
Median overall survival was 7.50 months (95% confidence interval [CI] = 5.62–11.15 months) in the ICI group vs 4.04 months (95% CI = 3.03–5.03 months) in the best supportive care group (hazard ratio [HR] = 0.59, 95% CI = 0.43–0.80, P < .001).
On multivariate analysis, the hazard ratio for overall survival for the ICI group vs the best supportive care group was 0.55 (95% CI = 0.35–0.86, P < .001). Other factors associated with increased risk of death were presence of portal vein tumor thrombosis (HR = 2.02, P < .001), an Eastern Cooperative Oncology Group performance score of > 1 (HR = 1.31, P = .06), and an alpha-fetoprotein level of ≥ 400 ng/mL (HR = 1.75, P < .001).
The investigators concluded, “The results of this case series provide comparative evidence of improved survival in association with ICI treatment compared with best supportive care in patients with unresectable hepatocellular carcinoma with CP-B liver dysfunction.”
David James Pinato, MD, PhD, of Imperial College London, Department of Surgery & Cancer, Hammersmith Hospital, London, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
