Immunotherapy Efficacy in Advanced Hepatocellular Carcinoma in a Diverse and Underserved Population in the United States

Autor: Bteich F, Desai K, Zhang C, Kaur A, Levy RA, Bioh L, Wang A, Sultana S, Kaubisch A, Kinkhabwala M, Bellemare S, Fidvi S, Kanmaniraja D, Berkenblit R, Moon JY, Adedimeji A, Tow CY, Saenger Y
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Journal of Hepatocellular Carcinoma, Vol Volume 11, Pp 257-269 (2024)
Druh dokumentu: article
ISSN: 2253-5969
Popis: Fernand Bteich,1 Kush Desai,1 Chenxin Zhang,1,2 Anahat Kaur,3 Rachel A Levy,1 Lydia Bioh,1 Aaron Wang,1 Sharmin Sultana,1 Andreas Kaubisch,1 Milan Kinkhabwala,1,4 Sarah Bellemare,1,4 Shabnam Fidvi,5 Devaraju Kanmaniraja,5 Robert Berkenblit,5 Jee-Young Moon,1,2 Adebola Adedimeji,2 Clara Y Tow,6 Yvonne Saenger1 1Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA; 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Medicine, Division of Medical Oncology, Jacobi Medical Center, Bronx, NY, USA; 4Department of General Surgery, Division of Abdominal Transplantation, Montefiore Medical Center, Bronx, NY, USA; 5Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA; 6Department of Medicine, Division of Transplant Hepatology, Montefiore Medical Center, Bronx, NY, USACorrespondence: Yvonne Saenger, Montefiore Einstein Comprehensive Cancer Center, Department of Oncology, Albert Einstein College of Medicine, Golding Building, Room 701, 1300 Morris Park Avenue, Bronx, NY, 10461, USA, Tel +1 718-430-2715, Email yvonne.saenger@einsteinmed.eduBackground: : Incidence of hepatocellular cancer (HCC) in the Bronx is 61% higher than the rest of New York State. Underserved populations are not well represented in clinical trials of immune checkpoint inhibitors (ICI).Methods: Demographics were tabulated for 194 patients treated with ICI at the Montefiore-Einstein Comprehensive Cancer Center (MECCC) between 2017 and 2022. Categorical variables were analyzed by Chi-squared test, and survival was analyzed using Kaplan–Meier (KM) curves.Results: MECCC patients were 40.7% Hispanic and 20.6% Black, compared with 3% and 2%, respectively, in the landmark IMbrave 150 study. Median overall survival (mOS) on ICI was 9.0 months, 25.0 months for the 100 (51.5%) favorable-prognosis Child Pugh A (CPA) patients included in HCC clinical trials. Disease control rate (DCR) was 58.5% among 123 evaluable patients per mRECIST 1.1. Baseline liver function, as defined by CP and the Model for End-Stage Liver Disease-Sodium (MELD-Na), correlated with survival (p < 0.001). Hepatitis C Virus (HCV) and alcoholism were over-represented relative to National Cancer Institute (NCI) data (56.2% vs 4.7% and 38.7% vs 8.2%, respectively). HCV treatment correlated with prolonged survival in infected patients (p = 0.0017). AFP decline correlated with response (p = 0.001). Hispanic patients lived longer when clinical variables were controlled for (mOS 52 vs 23 months; p = 0.011).Conclusion: In an underserved HCC population, ICI yielded a DCR of 58.5% and low rates of severe toxicity. This work highlights ICI efficacy in minority groups, a need for earlier HCC diagnosis and for studies of genetic and environmental factors in Hispanics with HCC.Keywords: hepatocellular carcinoma, systemic therapy, immunotherapy, checkpoint inhibitors, minorities
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