Prognostic impact of C-reactive protein and alpha-fetoprotein in immunotherapy score in hepatocellular carcinoma patients treated with atezolizumab plus bevacizumab: A multicenter retrospective study

Abstract Aim : This study aimed to investigate the utility of C-reactive protein (CRP) and alpha-fetoprotein (AFP) in immunotherapy (CRAFITY) score in hepatocellular carcinoma (HCC) patients receiving atezolizumab and bevacizumab (Atez/Bev). Methods : This retrospective cohort study included a total of 297 patients receiving Atez/Bev from September 2020 to November 2021 at 17 different institutions and hospital groups in Japan. Patients with AFP≥100 ng/mL and those with CRP≥1 mg/dL were assigned a CRAFITY score of 1 point. Results : The patients were assigned CRAFITY scores of 0 points (n=147 [49.5%]), 1 point (n=111 [37.4%]), and 2 points (n=39 [13.1%]). AFP≥100 ng/mL and CRP≥1.0 mg/dL were significantly associated with progression-free survival (PFS) and overall survival (OS). The median PFS in the CRAFITY score 0, 1, and 2 groups was 11.8 months (95% confidence interval [CI] 6.4-not applicable [NA]), 6.5 months (95% CI 4.6-8.0), and 3.2 months (95% CI 1.9-5.0), respectively (p<0.001). The median OS in patients with CRAFITY score 0, 1 and 2 was not reached, 14.3 months (95% CI 10.5-NA), and 11.6 months (95% CI 4.9-NA), respectively. The percentage of patients with grade ≥3 liver injury, any grade of decreased appetite, any grade of proteinuria, any grade of fever, and any grade of fatigue was lowest in patients with a CRAFITY score of 0, followed by patients with CRAFITY scores of 1 and 2. Conclusions : The CRAFITY score is simple and could be useful for predicting therapeutic outcomes and treatment-related adverse events.