Kikuchi Tatsuya, Takeuchi Yasuto, Nouso Kazuhiro, Kariyama Kazuya, Kuwaki Kenji, Toshimori Junichi, Iwado Shota, Moriya Akio, Hagihara Hiroaki, Takabatake Hiroyuki, Tada Toshifumi, Yasunaka Tetsuya, Sakata Masahiro, Sue Masahiko, Miyake Nozomi, Adachi Takuya, Wada Nozomu, Onishi Hideki, Shiraha Hidenori, Takaki Akinobu, Otsuka Motoyuki
Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama City, Japan.
Department of Regenerative Medicine, Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
Liver Int. 2024 Jun;44(6):1456-1463. doi: 10.1111/liv.15907. Epub 2024 Mar 15.
To identify predictive factors associated with successful transition to conversion therapy following combination therapy with atezolizumab and bevacizumab in the treatment of unresectable hepatocellular carcinoma (HCC).
In total, 188 patients with HCC, who received atezolizumab plus bevacizumab combination therapy as the first-line chemotherapy, were studied. Patients who achieved complete response (CR) with systemic chemotherapy alone were excluded. Clinical factors possibly linked to successful transition to conversion therapy and the achievement of cancer-free status were identified.
Fifteen (8.0%) patients underwent conversion therapy. In the conversion group, there was a significantly higher proportion of patients with Barcelona Clinic Liver Cancer (BCLC) stage A or B (73.3% versus [vs.] 45.1%; p = .03) and tended to have lower Child-Pugh scores and alpha-fetoprotein levels. Multivariate analysis revealed that BCLC stage was a predictive factor for the implementation of conversion therapy (A or B; odds ratio 3.7 [95% CI: 1.1-13]; p = .04). Furthermore, 10 (66.7%) patients achieved cancer-free status and exhibited a smaller number of intrahepatic lesions at the start of treatment (3.5 vs. 7; p < .01), and a shorter interval between systemic chemotherapy induction and conversion therapy (131 vs. 404 days; p < .01). In addition, the rate of achieving cancer-free status by undergoing surgical resection or ablation therapy was significantly higher (p = .03).
BCLC stage was the sole predictive factor for successful transition to conversion therapy when using combination therapy with atezolizumab and bevacizumab to treat HCC. Furthermore, a small number of intrahepatic lesions and early transition to conversion therapy were associated with the achievement of cancer-free status.
确定在不可切除肝细胞癌（HCC）治疗中，阿替利珠单抗与贝伐单抗联合治疗后成功过渡至转化治疗的相关预测因素。
共研究了188例接受阿替利珠单抗加贝伐单抗联合治疗作为一线化疗的HCC患者。仅接受全身化疗达到完全缓解（CR）的患者被排除。确定了可能与成功过渡至转化治疗及实现无癌状态相关的临床因素。
15例（8.0%）患者接受了转化治疗。在转化组中，巴塞罗那临床肝癌（BCLC）分期为A或B期的患者比例显著更高（73.3%对45.1%；p = 0.03），且Child-Pugh评分和甲胎蛋白水平往往较低。多因素分析显示，BCLC分期是转化治疗实施的预测因素（A或B期；比值比3.7 [95%置信区间：1.1 - 13]；p = 0.04）。此外，10例（66.7%）患者实现了无癌状态，且在治疗开始时肝内病灶数量较少（3.5个对7个；p < 0.01），全身化疗诱导与转化治疗之间的间隔时间较短（131天对404天；p < 0.01）。另外，通过手术切除或消融治疗实现无癌状态的比例显著更高（p = 0.03）。
在使用阿替利珠单抗和贝伐单抗联合治疗HCC时，BCLC分期是成功过渡至转化治疗的唯一预测因素。此外，肝内病灶数量少和早期过渡至转化治疗与实现无癌状态相关。
