Outcome and management of patients with hepatocellular carcinoma who achieved complete response to immunotherapy-based systemic therapy

医学 肝细胞癌 内科学 全身疗法 免疫疗法 完全响应 结果(博弈论) 肿瘤科 癌症 化疗 数学 数理经济学 乳腺癌
作者
Bernhard Scheiner,Beodeul KANG,Lorenz Balcar,Iuliana‐Pompilia Radu,Florian P. Reiter,Gordan Adžić,Jiang Guo,Xu Gao,Xiao Yuan,Long Cheng,Joao Gorgulho,Michael Schultheiß,Frederik Peeters,Florian Hucke,Najib Ben Khaled,Ignazio Piseddu,Alexander Philipp,Friedrich Sinner,Antonio D’Alessio,Katharina Pomej
出处
期刊:Hepatology [Lippincott Williams & Wilkins]
被引量:5
标识
DOI:10.1097/hep.0000000000001163
摘要

Background and Aims: The outcome of patients with HCC who achieved complete response (CR) to immune-checkpoint inhibitor (ICI)–based systemic therapies is unclear. Approach and Results: Retrospective study of patients with HCC who had CR according to modified Response Evaluation Criteria in Solid Tumors (CR-mRECIST) to ICI-based systemic therapies from 28 centers in Asia, Europe, and the United States. Of 3933 patients with HCC treated with ICI-based noncurative systemic therapies, 174 (4.4%) achieved CR-mRECIST, and 97 (2.5%) had CR according to RECISTv1.1 (CR-RECISTv1.1) as well. The mean age of the total cohort (male, 85%; Barcelona-Clinic Liver Cancer-C, 70%) was 65.9±9.8 years. The majority (83%) received ICI-based combination therapies. Median follow-up was 32.2 (95% CI: 29.9–34.4) months. One- and 3-year overall survival rates were 98% and 86%. One- and 3-year recurrence-free survival rates were excellent in patients with CR-mRECIST-only and CR-RECISTv1.1 (78% and 55%; 70% and 42%). Among patients who discontinued ICIs for reasons other than recurrence, those who received immunotherapy for ≥6 months after the first mRECIST CR had a longer recurrence-free survival than those who discontinued immunotherapy earlier ( p =0.008). Of 9 patients who underwent curative surgical conversion therapy, 8 (89%) had pathological CR (CR-RECISTv1.1, n= 2/2; CR-mRECIST-only, n= 6/7). Conclusions: Overall survival and recurrence-free survival of patients with CR-mRECIST-only and CR-RECISTv1.1 were excellent, and 6 of 7 patients with CR-mRECIST-only who underwent surgical conversion therapy had pathological CR. Despite potential limitations, these findings support the use of mRECIST in the context of immunotherapy for clinical decision-making. When considering ICI discontinuation, treatment for at least 6 months beyond CR seems advisable.
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