Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Oncol Res Treat. 2020;43(5):211-220. doi: 10.1159/000505933. Epub 2020 Feb 26.
The tumor microenvironments of different organs often differ and thus may affect the immunotherapy response.
This study elucidated that the efficacy of programmed cell death protein-1 (PD-1) inhibitors varies across different metastatic sites among individuals with advanced hepatocellular carcinoma (HCC).
We retrospectively analyzed treatment outcomes in advanced HCC patients receiving PD-1 inhibitors with or without a combination of tyrosine kinase inhibitors (TKIs). Both the overall response rate (ORR) and organ-specific response rate (OSRR) were assessed using Response Evaluation Criteria in Solid Tumors 1.1 criteria. A survival analysis and its predictors were determined using a multivariate analysis.
We analyzed 42 advanced HCC patients (median age: 58.0 years; 78.6% males). Thirty (71.4%) patients were sorafenib-experienced and 27 (64.3%) were administered a combination of TKIs. The ORR was 14.3% and the disease control rate was 33.3%. The median overall survival (OS) and progression-free survival (PFS) were 12.0 and 2.9 months, respectively. The OSRRs were 14.7, 23.8, 28.6, and 50.0% for the liver, lungs, lymph nodes, and vascular response, respectively. The multivariate analysis indicated that the vascular response was significantly associated with PFS. ECOG performance status was a significant independent predictor of OS.
PD-1 inhibitors improved OS and PFS in advanced HCC patients. Their efficacies varied among the metastatic locations regardless of the combination of TKIs; in particular, a higher response in vascular metastases was correlated with a longer PFS. PD-1 inhibitors may deliver a synergistic benefit in patients undergoing traditional therapy and progression in other organs in vascular responders.
不同器官的肿瘤微环境常常不同，因此可能会影响免疫治疗的反应。
本研究阐明了程序性细胞死亡蛋白-1（PD-1）抑制剂在晚期肝细胞癌（HCC）患者不同转移部位的疗效存在差异。
我们回顾性分析了接受 PD-1 抑制剂单药或联合酪氨酸激酶抑制剂（TKI）治疗的晚期 HCC 患者的治疗结果。使用实体瘤反应评价标准 1.1 标准评估总体缓解率（ORR）和器官特异性缓解率（OSRR）。使用多变量分析确定生存分析及其预测因素。
我们分析了 42 例晚期 HCC 患者（中位年龄：58.0 岁；78.6%为男性）。30 例（71.4%）患者曾接受索拉非尼治疗，27 例（64.3%）患者接受了 TKI 联合治疗。ORR 为 14.3%，疾病控制率为 33.3%。中位总生存期（OS）和无进展生存期（PFS）分别为 12.0 个月和 2.9 个月。肝脏、肺部、淋巴结和血管反应的 OSRR 分别为 14.7%、23.8%、28.6%和 50.0%。多变量分析表明，血管反应与 PFS 显著相关。ECOG 表现状态是 OS 的显著独立预测因素。
PD-1 抑制剂可改善晚期 HCC 患者的 OS 和 PFS。无论是否联合 TKI，它们在转移部位的疗效均存在差异；特别是，血管转移部位的更高反应与更长的 PFS 相关。在接受传统治疗且其他器官发生进展的血管反应者中，PD-1 抑制剂可能会产生协同获益。
