Liver Function Linked to OS Benefit in Liver Cancer

TOPLINE:

In patients with hepatocellular carcinoma (HCC) who received immunotherapy, median overall survival was 20.6 months in those with preserved liver function. Metabolic dysfunction-associated steatotic liver disease, liver function metrics, and presence of varices independently predicted survival outcomes.

METHODOLOGY:

• Recent clinical trials have demonstrated the superiority of immunotherapy-based combinations over multikinase inhibitors in treating HCC. The combination of atezolizumab plus bevacizumab was the first treatment to show superiority over sorafenib, followed by successful trials of dual immunotherapy regimens.
• A Brazilian multicenter observational study included 163 patients with unresectable or metastatic HCC treated with immunotherapy between August 2020 and March 2024 across 14 centers in 11 Brazilian states.
• Researchers administered atezolizumab (1200 mg) plus bevacizumab (15 mg/kg) intravenously every 3 weeks as the predominant regimen (77.9%), while durvalumab (1500 mg) with single-dose tremelimumab (300 mg) was given every 28 days.
• Analysis included a survival assessment using the Kaplan-Meier method and Cox regression for identifying predictors, with a data cutoff of October 24, 2024.
• Patient monitoring included periodic radiologic response assessment per Response Evaluation Criteria in Solid Tumors v1.1 criteria and adverse event tracking using National Cancer Institute Common Terminology Criteria for Adverse Events v5.0.

TAKEAWAY:

• Overall survival reached 14.7 months (95% CI, 11.6-24.5) for the entire cohort, with 12- and 24-month survival rates of 57.0% (95% CI, 47.7%-65.3%) and 41.4% (95% CI, 30.1%-51.5%), respectively.
• Patients with Child-Pugh A and Eastern Cooperative Oncology Group performance status 0-1 (n = 116) achieved a median overall survival of 20.6 months (95% CI, 12.4-25.8).
• Immune-related adverse events occurred in 19.6% of patients, primarily involving thyroid disorders and skin manifestations, while bevacizumab-related events included variceal (n = 6) and other bleeding events (n = 7).
• Albumin-bilirubin grade 2 to 3 (hazard ratio [HR], 2.87; 95% CI, 1.31-6.31; P = .008), metabolic dysfunction-associated steatotic liver disease (HR, 3.87; 95% CI, 1.37-0.94; P = .011), and esophagogastric varices (HR, 1.67; 95% CI, 1.39-1.90; P = .005) independently predicted worse survival.

IN PRACTICE:

“In a real-world setting, immunotherapy-based treatments demonstrated effectiveness and safety profiles consistent with clinical trials, although survival was influenced by liver function, etiology, and baseline variceal status. These findings highlight the relevance of baseline liver disease characteristics in guiding immunotherapy in HCC and underscore the need for tailored management strategies,” wrote the authors of the study.

SOURCE:

The study was led by Leonardo Gomes da Fonseca, MD, PhD, Oncologia D’Or and Instituto D’Or de Pesquisa e Ensino in Sao Paulo, Brazil. It was published online on July 30 in JCO Global Oncology.

LIMITATIONS:

According to the authors, the study’s retrospective nature introduced limitations including incomplete data availability, lack of standardization in previous eligibility assessments, and potential misreporting of adverse events. The absence of independent review may have affected the radiologic assessment and progression-free survival results. Additionally, the predominant use of atezolizumab-bevacizumab (77.9%) as first-line therapy may not reflect outcomes expected with double immunotherapy regimens.

DISCLOSURES:

da Fonseca disclosed receiving honoraria from AstraZeneca, Roche, Servier, Bayer, and MSD. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.