Predictive factors and survival outcome of conversion therapy for unresectable hepatocellular carcinoma patients receiving atezolizumab and bevacizumab: Comparative analysis of conversion, partial response and complete response patients.

Autor: Hatanaka T; Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan., Kakizaki S; Department of Clinical Research, NHO Takasaki General Medical Center, Takasaki, Japan.; Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan., Hiraoka A; Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan., Tada T; Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan., Hirooka M; Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan., Kariyama K; Department of Gastroenterology, Okayama City Hospital, Okayama, Japan., Tani J; Department of Gastroenterology and Neurology, Kagawa University, Kita-Gun, Takamatsu, Japan., Atsukawa M; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan., Takaguchi K; Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan., Itobayashi E; Department of Gastroenterology, Asahi General Hospital, Asahi, Japan., Fukunishi S; Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Diseases, Hyogo Medical University, Nishinomiya, Japan., Tsuji K; Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan., Ishikawa T; Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan., Tajiri K; Department of Gastroenterology, Toyama University Hospital, Toyama, Japan., Toyoda H; Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan., Ogawa C; Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan., Nishikawa H; Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan., Nishimura T; Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Diseases, Hyogo Medical University, Nishinomiya, Japan., Kawata K; Hepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Japan., Kosaka H; Department of Surgery, Kansai Medical University, Hirakata, Japan., Naganuma A; Department of Gastroenterology, NHO Takasaki General Medical Center, Takasaki, Japan., Yata Y; Department of Gastroenterology, Hanwa Memorial Hospital, Osaka, Japan., Ohama H; Department of Gastroenterology, Takarazuka City Hospital, Takarazuka, Japan., Kuroda H; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan., Matono T; Department of Gastroenterology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan., Aoki T; Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan., Kanayama Y; Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan., Tanaka K; Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan., Tada F; Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan., Nouso K; Department of Gastroenterology, Okayama City Hospital, Okayama, Japan., Morishita A; Department of Gastroenterology and Neurology, Kagawa University, Kita-Gun, Takamatsu, Japan., Tsutsui A; Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan., Nagano T; Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan., Itokawa N; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan., Okubo T; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan., Arai T; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan., Imai M; Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan., Nakamura S; Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan., Enomoto H; Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Diseases, Hyogo Medical University, Nishinomiya, Japan., Kaibori M; Department of Surgery, Kansai Medical University, Hirakata, Japan., Hiasa Y; Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan., Kudo M; Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan., Kumada T; Gifu Kyoritsu University, Ogaki, Japan.
Jazyk: angličtina
Zdroj: Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2024 Nov; Vol. 60 (10), pp. 1361-1373. Date of Electronic Publication: 2024 Sep 04.
DOI: 10.1111/apt.18237
Abstrakt: Aim: This study aims to investigate the predictive factors for conversion therapy in patients with unresectable hepatocellular carcinoma (uHCC) and to evaluate the prognosis of conversion cases by comparing them with partial response (PR) and complete response (CR) cases.
Methods: In this retrospective multicentre study, we included a total of 946 uHCC patients treated with atezolizumab and bevacizumab (Atez/Bev) from September 2020 to September 2023.
Results: Out of the patients, 43 (4.5%) received conversion therapy following Atez/Bev treatment. The overall response rate was 65.1% and 23.7% in the conversion and non-conversion group, respectively, with a statistical significance (p < 0.001). Multivariate analyses identified that BCLC stage B or an earlier stage (p = 0.045), absence of macrovascular invasion and extrahepatic spread (p = 0.045), and a low value of neutrophil to lymphocyte ratio (p = 0.04) were significantly favourable predictive factors associated with conversion therapy. The conversion group showed significantly better survival compared to the non-conversion group (p < 0.001). In the landmark analysis at 6, 12 and 18 months, the conversion group exhibited better survival compared to PR patients in the non-conversion group (p = 0.04, 0.01 and 0.03, respectively) and there were no significant differences in the overall survival (OS) between the conversion group and patients who achieved a CR (p = 0.7, 1.0 and 0.3, respectively).
Conclusions: Patients with low tumour burden and low value of NLR were more likely to undergo conversion therapy. The OS of patients undergoing conversion therapy showed better survival compared to those achieving PR and was comparable to those with CR patients. Conversion therapy could be considered if feasible.
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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