Curative treatment following first-line immunotherapy is infrequently received, but when it was utilized, it significantly improved overall survival outcomes for patients with hepatocellular carcinoma, according to findings from a study published in Liver Cancer. The risk for death was improved by 85% with use of resection, transplantation, and/or local ablation following upfront immunotherapy.
“The data we reviewed showed that patients who received follow-up transplants or tumor removal after immunotherapy [that] reduced the size of their tumors lived much longer than patients who just remained on immunotherapy,” stated senior study author Ju Dong Yang, MD, Medical Director, Liver Cancer Program, Cedars-Sinai Cancer, Los Angeles, California.
Study Methods
The investigators identified 4,329 patients with hepatocellular carcinoma from the National Cancer Database who received first-line immunotherapy between 2017 and 2020. These patients were classified as either receiving immunotherapy with or without subsequent curative treatment, which included resection, transplantation, and local ablation.
“Performing liver transplant following immunotherapy isn’t yet common practice,” Dr. Yang explained. “This is unfortunate, as patients with advanced liver cancer often die without such treatment—even if their cancer is under control—because they also have other liver ailments. A transplant leaves the patient with a healthy liver.”
Analysis then determined factors associated with overall survival and also looked at propensity-score matching and the inverse probability of treatment weighting.
Key Study Findings
Of the selected patients with hepatocellular carcinoma, only 138 (3.2%) received curative treatment following first-line immunotherapy, with a median time of 3.0 months between the treatments. The receipt of curative treatment was more likely to happen in an academic health system (odds ratio = 3.40; 95% confidence interval [CI] = 1.68–7.38).
Overall survival was significantly longer in patients who received curative treatment conversion (hazard ratio [HR] = 0.15; 95% CI = 0.11–0.22), including after propensity-score matching (HR = 0.20; 95% CI = 0.13–0.30) and inverse probability of treatment weighting–adjusted analyses (HR = 0.19; 95% CI = 0.11–0.31). Median overall survival was not reached for patients who received subsequent curative treatment vs 10 months for those who did not.
Going forward, Dr. Yang is planning to launch a new study in the coming months to further study the need for more aggressive treatment for patients with hepatocellular carcinoma.
Disclosure: Dr. Yang's research was supported by National Cancer Institute grants. Dr. Yang reported consulting services for AstraZeneca, Eisai, Exact Sciences, Exelixis, and Fujifilm Medical Sciences. For full disclosures of the study authors, visit karger.com.
