Immune Checkpoint Inhibitors for Patients With Child-Pugh Class B vs A Advanced Hepatocellular Carcinoma

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In a systematic review and meta-analysis reported in JAMA Oncology, Xie et al explored outcomes associated with immune checkpoint inhibition among patients with advanced hepatocellular carcinoma with Child-Pugh B vs Child-Pugh A liver function.

Study Details

The analysis included 22 studies (randomized trials, cohort studies, or single-group studies) reported through June 2022, representing 699 patients with Child-Pugh B and 2,114 with Child-Pugh A advanced hepatocellular carcinoma treated with immune checkpoint inhibitors.

Key Findings

Overall, patients in the Child-Pugh B group had an objective response rate of 14% (95% confidence interval [CI] = 11%–17%) and a disease control rate of 46% (95% CI = 36%–56%). Median progression-free survival was 2.68 months (95% CI =1.85–3.52 months) and median overall survival was 5.49 months (95% CI = 3.57–7.42 months).

Compared with the Child-Pugh A group, the Child-Pugh B group had significantly poorer objective response rate (odds ratio [OR] = 0.59, 95% CI = 0.43–0.81, P < .001), disease control rate (OR = 0.64, 95% CI = 0.50–0.81, P < .001), progression-free survival (hazard ratio [HR] = 1.69, 95% CI = 1.41–2.03, P < .001), and overall survival (HR = 2.72, 95% CI = 2.34–3.16, P < .001).

Any-grade treatment-related adverse events occurred in 40% (95% CI = 34%–47%) of patients in the Child-Pugh B group vs 47% (95% CI = 24%–71%) in the Child-Pugh A group (OR = 0.75, 95% CI = 0.31–1.77); treatment-related grade ≥ 3 adverse events occurred in 12% (95% CI = 6%–23%) vs 11% (95% CI = 6%–19%; OR = 1.01, 95% CI = 0.62–1.64).

The investigators concluded, “The findings of this systematic review and meta-analysis suggest that although the safety of immune checkpoint inhibitor treatment was comparable between patients with hepatocellular carcinoma with vs without advanced liver disease and the treatment resulted in a significant number of radiologic responses, survival outcomes are still inferior in patients with worse liver function. More study is needed to determine the effectiveness of immune checkpoint inhibitor treatment in this population.”

David J. Pinato, MD, PhD, of Imperial College London, and Fanpu Ji, MD, PhD, of The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China, are the corresponding authors for the JAMA Oncology article.

Disclosure: This study was supported by the National Natural Science Foundation of China and others. For full disclosures of the study authors, visit

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