TY - JOUR
T1 - Early Hepatic Decompensation Identifies Patients with Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab or Sorafenib at Highest Risk of Death
AU - Cabibbo, Giuseppe
AU - Celsa, Ciro
AU - Battaglia, Salvatore
AU - Enea, Marco
AU - Di Maria, Gabriele
AU - Grova, Alessandro
AU - Ciccia, Roberta
AU - Manfredi, Giulia F.
AU - Iavarone, Massimo
AU - Vogel, Arndt
AU - Singal, Amit G.
AU - Reig, Maria
AU - Pinato, David J.
AU - Cammà, Calogero
N1 - Publisher Copyright:
©2024 American Association for Cancer Research.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - Purpose: The prognosis of patients with unresectable hepatocellular carcinoma (HCC) and compensated cirrhosis is influenced by cancer progression. Data on the incidence and the prognostic role of clinical hepatic decompensation (CHD) following immune checkpoint inhibitor therapy are lacking. We aimed to assess whether early CHD within 3 months from commencement of systemic therapy affects overall survival (OS) of patients treated with atezolizumab plus bevacizumab or sorafenib. Patients and Methods: Individual patient data from the IMbrave150 trial were analyzed. Cumulative incidence of CHD was assessed by competing risk analysis against HCC radiologic progression. Early CHD and HCC radiologic progression were assessed as predictors of OS by the time-dependent Cox model. Results: The 3- and 12-month rates of CHD were 7% and 12%, respectively, whereas the 3- and 12-month rates of HCC radiologic progression were 23% and 52%, respectively. Albumin–bilirubin grade 2 [subdistribution HR (sHR) = 1.79, 95% confidence interval (CI), 1.01–3.19; P = 0.049], INR (sHR = 1.97, 95% CI, 1.64–2.37; P < 0.001), and presence of neoplastic macrovascular invasion (sHR = 2.01, 95% CI, 1.14–3.54; P = 0.020) were independently associated with higher risk of CHD. Early CHD (HR = 7.56, 95% CI, 4.47–12.8) and early HCC radiologic progression (HR = 5.92, 95% CI, 4.03–8.69), as first events, were independently associated with higher mortality. Conclusions: This study provides robust evidence that early CHD is associated with the highest risk of death in patients with unresectable HCC undergoing systemic treatment. Within well-compensated participants, albumin–bilirubin, INR, and macrovascular invasion identify a population at higher risk of decompensation. Inclusion of clinical decompensation events in future prospective clinical trials may improve characterization of OS from systemic therapy of HCC.
AB - Purpose: The prognosis of patients with unresectable hepatocellular carcinoma (HCC) and compensated cirrhosis is influenced by cancer progression. Data on the incidence and the prognostic role of clinical hepatic decompensation (CHD) following immune checkpoint inhibitor therapy are lacking. We aimed to assess whether early CHD within 3 months from commencement of systemic therapy affects overall survival (OS) of patients treated with atezolizumab plus bevacizumab or sorafenib. Patients and Methods: Individual patient data from the IMbrave150 trial were analyzed. Cumulative incidence of CHD was assessed by competing risk analysis against HCC radiologic progression. Early CHD and HCC radiologic progression were assessed as predictors of OS by the time-dependent Cox model. Results: The 3- and 12-month rates of CHD were 7% and 12%, respectively, whereas the 3- and 12-month rates of HCC radiologic progression were 23% and 52%, respectively. Albumin–bilirubin grade 2 [subdistribution HR (sHR) = 1.79, 95% confidence interval (CI), 1.01–3.19; P = 0.049], INR (sHR = 1.97, 95% CI, 1.64–2.37; P < 0.001), and presence of neoplastic macrovascular invasion (sHR = 2.01, 95% CI, 1.14–3.54; P = 0.020) were independently associated with higher risk of CHD. Early CHD (HR = 7.56, 95% CI, 4.47–12.8) and early HCC radiologic progression (HR = 5.92, 95% CI, 4.03–8.69), as first events, were independently associated with higher mortality. Conclusions: This study provides robust evidence that early CHD is associated with the highest risk of death in patients with unresectable HCC undergoing systemic treatment. Within well-compensated participants, albumin–bilirubin, INR, and macrovascular invasion identify a population at higher risk of decompensation. Inclusion of clinical decompensation events in future prospective clinical trials may improve characterization of OS from systemic therapy of HCC.
UR - http://www.scopus.com/inward/record.url?scp=85213688050&partnerID=8YFLogxK
U2 - 10.1158/1078-0432.CCR-24-2582
DO - 10.1158/1078-0432.CCR-24-2582
M3 - Article
SN - 1078-0432
VL - 31
SP - 543
EP - 550
JO - Clinical Cancer Research
JF - Clinical Cancer Research
IS - 3
ER -
