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Zou H, Lei Q, Yan X, Lai Y, Ung COL, Hu H. Clinical Outcomes Associated with Monotherapy and Combination Therapy of Immune Checkpoint Inhibitors as First-Line Treatment for Advanced Hepatocellular Carcinoma in Real-World Practice: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2022; 15:260. [PMID: 36612256 PMCID: PMC9818755 DOI: 10.3390/cancers15010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs)-based therapy has recently been demonstrated to greatly ameliorate survival outcomes in advanced hepatocellular carcinoma (HCC). We aimed to evaluate clinical outcomes of ICIs-based monotherapy and combination therapy as first-line treatment of adults with advanced HCC in real-world practice by conducting a systematic literature review and meta-analysis. METHODS PubMed, Web of Science, and Embase were searched up to 25 April 2022. Retrospective or prospective real-world studies evaluating progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs) of patients with advanced HCC receiving first-line ICIs-based therapy were included. RESULTS Of 7805 studies retrieved, 38 were deemed eligible for inclusion. For patients receiving first-line ICIs-based therapy in real-world practice, the pooled median PFS and OS were 7.03 (95% CI: 5.55-8.51) and 14.39 (95% CI: 10.91-17.86) months. The ORR and DCR were 0.432 (95% CI: 0.327-0.538) and 0.756 (95% CI: 0.677-0.836), according to mRECIST 1.1, 0.317 (95% CI: 0.218-0.416) and 0.740 (95% CI: 0.644-0.835), judged by RECIST 1.1. The best outcomes of survival and response rate were observed in ICIs-based combination therapy of ICIs, TKIs, plus LRTs. Furthermore, ORR, DCR judged by mRECIST 1.1, and PFS could be potential prognostic factors for OS. CONCLUSIONS This research revealed diversified first-line ICIs-based therapies for advanced HCC in real-world practice. Future studies are needed to adopt prospective, multicentric and comparative designs to test the ICIs-based combination therapies, especially triple therapies of ICIs, TKIs, plus LRTs.
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Affiliation(s)
- Huimin Zou
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Qing Lei
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Xin Yan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yunfeng Lai
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao, China
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Xu H, Cao D, Zheng Y, Zhou D, Chen X, Lei J, Ge W, Xu X. Potential predictors for survival in hepatocellular carcinoma patients treated with immune checkpoint inhibitors: A meta-analysis. Int Immunopharmacol 2021; 100:108135. [PMID: 34530205 DOI: 10.1016/j.intimp.2021.108135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) are increasingly used in hepatocellular carcinoma (HCC) trials. However, the correlations between early endpoints, such as progression free survival (PFS), objective response rate (ORR), and disease control rate (DCR), and overall survival (OS) are unclear. In this study, the correlations between OS and other early endpoints were evaluated in HCC patients who received ICI. METHODS Pubmed and Embase were searched to October 2020. Clinical studies evaluating efficacy and outcomes of HCC patients treated with ICI were included. ORR, DCR, PFS and OS were extracted from individual studies. The Spearman's rank correlation coefficient and linear regression model were used to assess the correlation. RESULTS 74 studies involving 9001 HCC cases were included. For HCC patients treated with ICI, the pooled ORR and DCR were 16% (95% CI: 14-18%) and 52% (95% CI: 47-57%), and the median PFS and OS were 3.75 (95% CI: 2.88-4.90) months, and 13.20 (95% CI: 11.88-14.82) months, retrospectively. The correlation between ORR, DCR, PFS and OS were 0.35 (R2 = 0.21, p < 0.05), 0.43 (R2 = 0.18, p < 0.05), and 0.50 (R2 = 0.33, p < 0.05), respectively. Further, the association between PFS and OS of the combination strategy showed a better correlation (rs = 0.79, R2 = 0.75, p < 0.05). CONCLUSION These results suggest that PFS could be potential surrogates for OS, especially PFS for patients who treated with ICI combination regimen.
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Affiliation(s)
- Huilin Xu
- Department of Oncology, The Fifth Hospital of WuHan, WuHan, Hubei 430000, China
| | - Dedong Cao
- Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei 430000, China.
| | - Yongfa Zheng
- Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei 430000, China
| | - Dingjie Zhou
- Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei 430000, China
| | - Xin Chen
- Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei 430000, China
| | - Jinju Lei
- Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei 430000, China
| | - Wei Ge
- Department of Oncology, Taikang Tongji Hospital of Wuhan, WuHan, Hubei 430000, China
| | - Ximing Xu
- Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei 430000, China.
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Gonzalez-Cao M, Puertolas T, Riveiro M, Muñoz-Couselo E, Ortiz C, Paredes R, Podzamczer D, Manzano JL, Molto J, Revollo B, Carrera C, Mateu L, Fancelli S, Espinosa E, Clotet B, Martinez-Picado J, Cerezuela P, Soria A, Marquez I, Mandala M, Berrocal A. Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM). J Immunother Cancer 2021; 9:jitc-2020-001664. [PMID: 33782108 PMCID: PMC8009216 DOI: 10.1136/jitc-2020-001664] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 01/11/2023] Open
Abstract
Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.
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Affiliation(s)
- Maria Gonzalez-Cao
- Translational Cancer Research Unit, Instituto Oncologico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Teresa Puertolas
- Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Mar Riveiro
- Liver Unit, Department of Internal Medicine, Vall d'Hebron Hospital Universitari, Barcelona, Catalunya, Spain
| | - Eva Muñoz-Couselo
- Oncology Department, Vall d'Hebron Hospital Universitari, Barcelona, Catalunya, Spain
| | - Carolina Ortiz
- Oncology Department, Vall d'Hebron Hospital Universitari, Barcelona, Catalunya, Spain
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain.,Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Daniel Podzamczer
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Jose Luis Manzano
- Oncology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jose Molto
- IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain.,Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Boris Revollo
- IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain.,Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Cristina Carrera
- Dermatology Department, Melanoma Group IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Lourdes Mateu
- IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain.,Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Sara Fancelli
- Translational Cancer Research Unit, Instituto Oncologico Dr Rosell, Dexeus University Hospital, Barcelona, Spain.,Oncology Department, Azienda Ospedaliero Careggi, Firenze, Toscana, Italy
| | - Enrique Espinosa
- Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain.,Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, Badalona, Catalunya, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Catalan Institution for Research and Advanced Studies, Barcelona, Catalunya, Spain
| | - Pablo Cerezuela
- Oncology Department, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Ainara Soria
- Oncology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Ivan Marquez
- Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mario Mandala
- Oncology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alfonso Berrocal
- Oncology Department, Consorci Hospital General Universitari de Valencia, Valencia, Comunitat Valenciana, Spain
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Ng KYY, Wong LWJ, Ang AJS, Tan SH, Choo SP, Tai DW, Lee JJX. Real‐world efficacy and safety of immune checkpoint inhibitors in advanced hepatocellular carcinoma: Experience of a tertiary Asian Center. Asia Pac J Clin Oncol 2020; 17:e249-e261. [DOI: 10.1111/ajco.13454] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Kennedy Yao Yi Ng
- Division of Medical Oncology National Cancer Centre Singapore Singapore
| | | | | | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences National Cancer Centre Singapore Singapore
- Oncology Academic Programme Duke‐NUS Medical School Singapore
| | - Su Pin Choo
- Division of Medical Oncology National Cancer Centre Singapore Singapore
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Lee CH, Lee YB, Kim MA, Jang H, Oh H, Kim SW, Cho EJ, Lee KH, Lee JH, Yu SJ, Yoon JH, Kim TY, Kim YJ. Effectiveness of nivolumab versus regorafenib in hepatocellular carcinoma patients who failed sorafenib treatment. Clin Mol Hepatol 2020; 26:328-339. [PMID: 32460459 PMCID: PMC7364358 DOI: 10.3350/cmh.2019.0049n] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Several treatment options are currently available for patients with hepatocellular carcinoma (HCC) failing previous sorafenib treatment. We aimed to compare the effectiveness of regorafenib and nivolumab in these patients. Methods Consecutive HCC patients who received regorafenib or nivolumab after failure of sorafenib treatment were included. Primary endpoint was overall survival (OS) and secondary endpoints were time to progression, tumor response rate, and adverse events. Inverse probability of treatment weighting (IPTW) using the propensity score was conducted to reduce treatment selection bias. Results Among 150 study patients, 102 patients received regorafenib and 48 patients received nivolumab. Median OS was 6.9 (95% confidence interval [CI], 3.0–10.8) months for regorafenib and 5.9 (95% CI, 3.7–8.1) months for nivolumab (P=0.77 by log-rank test). In multivariable analysis, nivolumab was associated with prolonged OS (vs. regorafenib: adjusted hazard ratio [aHR], 0.54; 95% CI, 0.30–0.96; P=0.04). Time to progression was not significantly different between groups (nivolumab vs. regorafenib: aHR, 0.82; 95% CI, 0.51–1.30; P=0.48). HRs were maintained after IPTW. Objective response rates were 5.9% and 16.7% in patients treated with regorafenib and nivolumab, respectively (P=0.04). Conclusions After sorafenib failure, the use of nivolumab may be associated with improved OS and better objective response rate as compared to using regorafenib.
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Affiliation(s)
- Cheol-Hyung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Minseok Albert Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Heejoon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunwoo Oh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Woong Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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