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Kocheise L, Piseddu I, Vonderlin J, Tjwa ET, Buescher G, Meunier L, Goeggelmann P, Fianchi F, Dumortier J, Barciela MR, Gevers TJG, Beretta-Piccoli BT, Londoño MC, Frankova S, Roesner T, Joerg V, Schmidt C, Glaser F, Sutter JP, Fründt TW, Lohse AW, Huber S, von Felden J, Sebode M, Schulze K. Corrigendum: PD-1/PD-L1 immune checkpoint therapy demonstrates favorable safety profile in patients with autoimmune and cholestatic liver disease. Front Immunol 2024; 15:1369747. [PMID: 38327519 PMCID: PMC10848160 DOI: 10.3389/fimmu.2024.1369747] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2023.1326078.].
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Affiliation(s)
- Lorenz Kocheise
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ignazio Piseddu
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Joscha Vonderlin
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric T. Tjwa
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gustav Buescher
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Lucy Meunier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service Hépato-Gastro Entérologie, Hôpital St-Eloi, CHU Montpellier, Montpellier, France
| | - Pia Goeggelmann
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Francesca Fianchi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- CEMAD-Centro Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jérôme Dumortier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service d’hépato-gastroentérologie, Hôpital Edouard Herriot – Hospices civils de Lyon, Université de Lyon, Lyon, France
| | - Mar Riveiro Barciela
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tom J. G. Gevers
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
- Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Benedetta Terziroli Beretta-Piccoli
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Epatocentro Ticino, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
| | - Maria-Carlota Londoño
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Hospital Clinic Barcelona, FCRB-IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sona Frankova
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Thomas Roesner
- Department of Medical Oncology, National Center of Tumor Diseases (NCT) Heidelberg and Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Vincent Joerg
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Constantin Schmidt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Fabian Glaser
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jan P. Sutter
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Thorben W. Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marcial Sebode
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Kornelius Schulze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
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Kocheise L, Piseddu I, Vonderlin J, Tjwa ET, Buescher G, Meunier L, Goeggelmann P, Fianchi F, Dumortier J, Riveiro Barciela M, Gevers TJG, Terziroli Beretta-Piccoli B, Londoño MC, Frankova S, Roesner T, Joerg V, Schmidt C, Glaser F, Sutter JP, Fründt TW, Lohse AW, Huber S, von Felden J, Sebode M, Schulze K. PD-1/PD-L1 immune checkpoint therapy demonstrates favorable safety profile in patients with autoimmune and cholestatic liver disease. Front Immunol 2024; 14:1326078. [PMID: 38268921 PMCID: PMC10805832 DOI: 10.3389/fimmu.2023.1326078] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Immune checkpoint inhibitors (ICI) have revolutionized the treatment of many malignancies in recent years. However, immune-related adverse events (irAE) are a frequent concern in clinical practice. The safety profile of ICI for the treatment of malignancies in patients diagnosed with autoimmune and cholestatic liver disease (AILD) remains unclear. Due to this uncertainty, these patients were excluded from ICI clinical trials and ICI are withheld from this patient group. In this retrospective multicenter study, we assessed the safety of ICI in patients with AILD. Methods We contacted tertiary referral hospitals for the identification of AILD patients under ICI treatment in Europe via the European Reference Network on Hepatological Diseases (ERN RARE-LIVER). Fourteen centers contributed data on AILD patients with malignancies being treated with ICI, another three centers did not treat these patients with ICI due to fear of irAEs. Results In this study, 22 AILD patients under ICI treatment could be identified. Among these patients, 12 had primary biliary cholangitis (PBC), five had primary sclerosing cholangitis (PSC), four had autoimmune hepatitis (AIH), and one patient had an AIH-PSC variant syndrome. Eleven patients had hepatobiliary cancers and the other 11 patients presented with non-hepatic tumors. The applied ICIs were atezolizumab (n=7), durvalumab (n=5), pembrolizumab (n=4), nivolumab (n=4), spartalizumab (n=1), and in one case combined immunotherapy with nivolumab plus ipilimumab. Among eight patients who presented with grade 1 or 2 irAEs, three demonstrated liver irAEs. Cases with grades ≥ 3 irAEs were not reported. No significant changes in liver tests were observed during the first year after the start of ICI. Discussion This European multicenter study demonstrates that PD-1/PD-L1 inhibitors appear to be safe in patients with AILD. Further studies on the safety of more potent dual immune checkpoint therapy are needed. We conclude that immunotherapy should not categorically be withheld from patients with AILD.
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Affiliation(s)
- Lorenz Kocheise
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ignazio Piseddu
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Joscha Vonderlin
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric T. Tjwa
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gustav Buescher
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Lucy Meunier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service Hépato-Gastro Entérologie, Hôpital St-Eloi, CHU Montpellier, Montpellier, France
| | - Pia Goeggelmann
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Francesca Fianchi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- CEMAD-Centro Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Jérôme Dumortier
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Service d’hépato-gastroentérologie, Hôpital Edouard Herriot – Hospices civils de Lyon, Université de Lyon, Lyon, France
| | - Mar Riveiro Barciela
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tom J. G. Gevers
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
- Nutrim School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Benedetta Terziroli Beretta-Piccoli
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Epatocentro Ticino, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
| | - Maria-Carlota Londoño
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Liver Unit, Hospital Clinic Barcelona, FCRB-IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sona Frankova
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Thomas Roesner
- Department of Medical Oncology, National Center of Tumor Diseases (NCT) Heidelberg and Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Vincent Joerg
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Constantin Schmidt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Fabian Glaser
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jan P. Sutter
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Thorben W. Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marcial Sebode
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Kornelius Schulze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
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Scheiner B, Roessler D, Phen S, Lim M, Pomej K, Pressiani T, Cammarota A, Fründt TW, von Felden J, Schulze K, Himmelsbach V, Finkelmeier F, Deibel A, Siebenhüner AR, Shmanko K, Radu P, Schwacha-Eipper B, Ebert MP, Teufel A, Djanani A, Hucke F, Balcar L, Philipp AB, Hsiehchen D, Venerito M, Sinner F, Trauner M, D'Alessio A, Fulgenzi CA, Pinato DJ, Peck-Radosavljevic M, Dufour JF, Weinmann A, Kremer AE, Singal AG, De Toni EN, Rimassa L, Pinter M. Efficacy and safety of immune checkpoint inhibitor rechallenge in individuals with hepatocellular carcinoma. JHEP Rep 2022; 5:100620. [PMID: 36578451 PMCID: PMC9791167 DOI: 10.1016/j.jhepr.2022.100620] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background & Aims We investigated the efficacy and safety of immune checkpoint inhibitor (ICI) rechallenge in patients with hepatocellular carcinoma (HCC) who received ICI-based therapies in a previous systemic line. Methods In this international, retrospective multicenter study, patients with HCC who received at least two lines of ICI-based therapies (ICI-1, ICI-2) at 14 institutions were eligible. The main outcomes included best overall response and treatment-related adverse events. Results Of 994 ICI-treated patients screened, a total of 58 patients (male, n = 41; 71%) with a mean age of 65.0±9.0 years were included. Median systemic treatment lines of ICI-1 and ICI-2 were 1 (range, 1-4) and 3 (range, 2-9), respectively. ICI-based therapies used at ICI-1 and ICI-2 included ICI alone (ICI-1, n = 26, 45%; ICI-2, n = 4, 7%), dual ICI regimens (n = 1, 2%; n = 12, 21%), or ICI combined with targeted therapies/anti-VEGF (n = 31, 53%; n = 42, 72%). Most patients discontinued ICI-1 due to progression (n = 52, 90%). Objective response rate was 22% at ICI-1 and 26% at ICI-2. Responses at ICI-2 were also seen in patients who had progressive disease as best overall response at ICI-1 (n = 11/21; 52%). Median time-to-progression at ICI-1 and ICI-2 was 5.4 (95% CI 3.0-7.7) months and 5.2 (95% CI 3.3-7.0) months, respectively. Treatment-related adverse events of grade 3-4 at ICI-1 and ICI-2 were observed in 9 (16%) and 10 (17%) patients, respectively. Conclusions ICI rechallenge was safe and resulted in a treatment benefit in a meaningful proportion of patients with HCC. These data provide a rationale for investigating ICI-based regimens in patients who progressed on first-line immunotherapy in prospective trials. Impact and implications Therapeutic sequencing after first-line immune checkpoint inhibitor (ICI)-based therapy for advanced hepatocellular carcinoma (HCC) remains a challenge as no available second-line treatment options have been studied in immunotherapy-pretreated patients. Particularly, the role of ICI rechallenge in patients with HCC is unclear, as data from prospective trials are lacking. We investigated the efficacy and safety of ICI-based regimens in patients with HCC pretreated with immunotherapy in a retrospective, international, multicenter study. Our data provide the rationale for prospective trials investigating the role of ICI-based regimens in patients who have progressed on first-line immunotherapy.
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Key Words
- BOR, best overall response
- CR, complete response
- DCR, disease control rate
- HCC, hepatocellular carcinoma
- ICI, immune checkpoint inhibitor
- Immune checkpoint blocker
- Immunotherapy
- Liver cancer
- NE, not evaluable
- ORR, objective response rate
- OS, overall survival
- PD, progressive disease
- PR, partial response
- SD, stable disease
- Systemic therapy
- TRAEs, treatment-related adverse events
- TTP, time-to-progression
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Affiliation(s)
- Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniel Roessler
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Samuel Phen
- Department of Medicine, UT Southwestern Medical Center, Dallas TX, USA
| | - Mir Lim
- Department of Medicine, UT Southwestern Medical Center, Dallas TX, USA
| | - Katharina Pomej
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Antonella Cammarota
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milan), Italy,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele (Milan), Italy
| | - Thorben W. Fründt
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kornelius Schulze
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vera Himmelsbach
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Fabian Finkelmeier
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Ansgar Deibel
- Department of Hepatology and Gastroenterology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Alexander R. Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Zurich, Switzerland,Department of Medical Oncology and Hematology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Kateryna Shmanko
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Pompilia Radu
- Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland,Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Birgit Schwacha-Eipper
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Matthias P. Ebert
- Department of Internal Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,DKFZ-Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
| | - Andreas Teufel
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,Department of Internal Medicine II, Division of Hepatology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angela Djanani
- Department of Internal Medicine I, Division of Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Hucke
- Internal Medicine and Gastroenterology (IMuG), Including Centralized Emergency Service (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexander B. Philipp
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - David Hsiehchen
- Department of Medicine, UT Southwestern Medical Center, Dallas TX, USA
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von Guericke University Hospital, 39120 Magdeburg, Germany
| | - Friedrich Sinner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von Guericke University Hospital, 39120 Magdeburg, Germany
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Antonio D'Alessio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele (Milan), Italy,Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Claudia A.M. Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK,Department of Medical Oncology, University Campus Bio-Medico of Rome, Italy
| | - David J. Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Markus Peck-Radosavljevic
- Internal Medicine and Gastroenterology (IMuG), Including Centralized Emergency Service (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Jean-François Dufour
- Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas E. Kremer
- Department of Hepatology and Gastroenterology, University Hospital Zurich and University Zurich, Zurich, Switzerland,Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Amit G. Singal
- Department of Medicine, UT Southwestern Medical Center, Dallas TX, USA
| | - Enrico N. De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milan), Italy,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele (Milan), Italy
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Liver Cancer (HCC) Study Group Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria,Corresponding author. Address: Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Tel.: +43 1 40400 47440, fax: +43 1 40400 47350.
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4
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Scheiner B, Pomej K, Kirstein MM, Hucke F, Finkelmeier F, Waidmann O, Himmelsbach V, Schulze K, von Felden J, Fründt TW, Stadler M, Heinzl H, Shmanko K, Spahn S, Radu P, Siebenhüner AR, Mertens JC, Rahbari NN, Kütting F, Waldschmidt DT, Ebert MP, Teufel A, De Dosso S, Pinato DJ, Pressiani T, Meischl T, Balcar L, Müller C, Mandorfer M, Reiberger T, Trauner M, Personeni N, Rimassa L, Bitzer M, Trojan J, Weinmann A, Wege H, Dufour JF, Peck-Radosavljevic M, Vogel A, Pinter M. Prognosis of patients with hepatocellular carcinoma treated with immunotherapy - development and validation of the CRAFITY score. J Hepatol 2022; 76:353-363. [PMID: 34648895 DOI: 10.1016/j.jhep.2021.09.035] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Immunotherapy with atezolizumab plus bevacizumab represents the new standard of care in systemic front-line treatment of hepatocellular carcinoma (HCC). However, biomarkers that predict treatment success and survival remain an unmet need. METHODS Patients with HCC put on PD-(L)1-based immunotherapy were included in a training set (n = 190; 6 European centers) and a validation set (n = 102; 8 European centers). We investigated the prognostic value of baseline variables on overall survival using a Cox model in the training set and developed the easily applicable CRAFITY (CRP and AFP in ImmunoTherapY) score. The score was validated in the independent, external cohort, and evaluated in a cohort of patients treated with sorafenib (n = 204). RESULTS Baseline serum alpha-fetoprotein ≥100 ng/ml (hazard ratio [HR] 1.7; p = 0.007) and C-reactive protein ≥1 mg/dl (HR, 1.7; p = 0.007) were identified as independent prognostic factors in multivariable analysis and were used to develop the CRAFITY score. Patients who fulfilled no criterion (0 points; CRAFITY-low) had the longest median overall survival (27.6 (95% CI 19.5-35.8) months), followed by those fulfilling 1 criterion (1 point; CRAFITY-intermediate; 11.3 (95% CI 8.0-14.6) months), and patients meeting both criteria (2 points; CRAFITY-high; 6.4 (95% CI 4.8-8.1) months; p <0.001). Additionally, best radiological response (complete response/partial response/stable disease/progressive disease) was significantly better in patients with lower CRAFITY score (CRAFITY-low: 9%/20%/52%/20% vs. CRAFITY-intermediate: 3%/25%/36%/36% vs. CRAFITY-high: 2%/15%/22%/61%; p = 0.003). These results were confirmed in the independent validation set and in different subgroups, including Child-Pugh A and B, performance status 0 and ≥1, and first-line and later lines. In the sorafenib cohort, CRAFITY was associated with survival, but not radiological response. CONCLUSIONS The CRAFITY score is associated with survival and radiological response in patients receiving PD-(L)1 immunotherapy. The score may help with patient counseling but requires prospective validation. LAY SUMMARY The immunotherapy-based regimen of atezolizumab plus bevacizumab represents the new standard of care in systemic first-line therapy of hepatocellular carcinoma (HCC). Biomarkers to predict treatment outcome are an unmet need in patients undergoing immunotherapy for HCC. We developed and externally validated a score that predicts outcome in patients with HCC undergoing immunotherapy with immune checkpoint blockers.
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Affiliation(s)
- Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Katharina Pomej
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Department of Medicine I, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Florian Hucke
- Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Fabian Finkelmeier
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Oliver Waidmann
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Vera Himmelsbach
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Kornelius Schulze
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorben W Fründt
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Stadler
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Heinzl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Kateryna Shmanko
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stephan Spahn
- Department of Internal Medicine I, Eberhard-Karls University, Tuebingen, Germany
| | - Pompilia Radu
- Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Alexander R Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Zurich, Switzerland; Department of Medical Oncology and Hematology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Joachim C Mertens
- Department of Hepatology and Gastroenterology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Nuh N Rahbari
- Department of Surgery at University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Kütting
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | | | - Matthias P Ebert
- Department of Internal Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Teufel
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Internal Medicine II, Division of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sara De Dosso
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Lugano, Switzerland
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Tobias Meischl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Christian Müller
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria; CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Nicola Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele (Milan), Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele (Milan), Italy
| | - Michael Bitzer
- Department of Internal Medicine I, Eberhard-Karls University, Tuebingen, Germany
| | - Jörg Trojan
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Henning Wege
- 1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Center Esslingen, Klinikum Esslingen, 73730 Esslingen am Neckar, Germany
| | - Jean-François Dufour
- Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Markus Peck-Radosavljevic
- Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria.
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5
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Welland S, Leyh C, Finkelmeier F, Jefremow A, Shmanko K, Gonzalez-Carmona MA, Kandulski A, Jeliazkova P, Best J, Fründt TW, Djanani A, Pangerl M, Maieron A, Greil R, Fricke C, Sookthai D, Günther R, Schmiderer A, Wege H, Venerito M, Ehmer U, Müller M, Strassburg CP, Weinmann A, Siebler J, Waidmann O, Lange CM, Saborowski A, Vogel A. Real-World Data for Lenvatinib in Hepatocellular Carcinoma (ELEVATOR): A Retrospective Multicenter Study. Liver Cancer 2022; 11:219-232. [PMID: 35949288 PMCID: PMC9218621 DOI: 10.1159/000521746] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Lenvatinib is approved as first-line treatment for patients with advanced hepatocellular carcinoma (HCC). The efficacy of lenvatinib in Caucasian real-world patients is insufficiently defined. The purpose of this study was to evaluate the efficacy of lenvatinib in a multi-center cohort (ELEVATOR) from Germany and Austria. METHODS A retrospective data analysis of 205 patients treated with first-line systemic lenvatinib at 14 different sites was conducted. Overall survival, progression free survival, overall response rate and adverse event rates were assessed and analyzed. RESULTS Patients receiving lenvatinib in the real-world setting reached a median overall survival of 12.8 months, which was comparable to the results reported from the REFLECT study. Median overall survival (mOS) and progression free survival (mPFS) was superior in those patients who met the inclusion criteria of the REFLECT study compared to patients who failed to meet the inclusion criteria (mOS 15.6 vs 10.2 months, HR 0.55, 95% CI 0.38-0.81, p=0.002; mPFS 8.1 vs 4.8 months HR 0.65, 95% CI 0.46-0.91, p=0.0015). For patients with an impaired liver function according to the Albumin-Bilirubin (ALBI) grade, or reduced ECOG performance status ≥2, survival was significantly shorter compared to patients with sustained liver function (ALBI grade 1) and good performance status (ECOG performance status 0), respectively (HR 1.69, 95% CI 1.07-2.66, p=0.023; HR 2.25, 95% CI 1.19-4.23, p=0.012). Additionally, macrovascular invasion (HR 1.55, 95% CI 1.02-2.37, p=0.041) and an AFP ≥200 ng/mL (HR 1.56, 95% CI 1.03-2.34, p=0.034) were confirmed as independent negative prognostic factors in our cohort of patients with advanced HCC. CONCLUSION Overall, our data confirm the efficacy of lenvatinib as first-line treatment and did not reveal new or unexpected side effects in a large retrospective Caucasian real-world cohort, supporting the use of lenvatinib as meaningful alternative for patients that cannot be treated with IO-based combinations in first-line HCC.
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Affiliation(s)
- Sabrina Welland
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Catherine Leyh
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Fabian Finkelmeier
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - André Jefremow
- Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany,CCC-Erlangen EMN, Erlangen, Germany
| | - Kateryna Shmanko
- Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | | | - Arne Kandulski
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | - Petia Jeliazkova
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Best
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Thorben W. Fründt
- Department of Gastroenterology and Hepatology, University Medical Center, Hamburg, Germany
| | - Angela Djanani
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Maria Pangerl
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Andreas Maieron
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Richard Greil
- Salzburg Cancer Research Institute, Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Erlangen, Germany
| | - Christina Fricke
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Disorn Sookthai
- Institut für Klinische Krebsforschung IKF GmbH, Frankfurt, Germany
| | - Rainer Günther
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Andreas Schmiderer
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Henning Wege
- Department of Gastroenterology and Hepatology, University Medical Center, Hamburg, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University Hospital Magdeburg, Magdeburg, Germany
| | - Ursula Ehmer
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martina Müller
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | | | - Arndt Weinmann
- Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - Jürgen Siebler
- CCC-Erlangen EMN, Erlangen, Germany,Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Oliver Waidmann
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,*Arndt Vogel,
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6
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Schulze K, Felden JV, Fründt TW, Krause J, Werner T, Casar C, Jung C, Ittrich H, Sterneck M, Li J, Heumann A, Fischer L, Adam G, Lohse AW, Wege H. Early Detection of Hepatocellular Carcinoma Since the Introduction of the German Clinical Practice Guideline in 2013. Dtsch Arztebl Int 2021; 118:540-541. [PMID: 34612194 DOI: 10.3238/arztebl.m2021.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/11/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
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7
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Krause J, von Felden J, Casar C, Fründt TW, Galaski J, Schmidt C, Jung C, Ittrich H, Weidemann SA, Krech T, Heumann A, Li J, Fischer L, Sauter G, Lohse AW, Wege H, Schulze K. Hepatocellular carcinoma: Intratumoral EpCAM-positive cancer stem cell heterogeneity identifies high-risk tumor subtype. BMC Cancer 2020; 20:1130. [PMID: 33225916 PMCID: PMC7682021 DOI: 10.1186/s12885-020-07580-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The translational interest in the intratumoral heterogeneity of hepatocellular carcinoma (HCC) has been increasing. The dismal prognosis of this pathology is linked to the features of the HCC harbouring cancer stem cells (CSC), represented by EpCAM-expression. However, the extent of the impact of intratumoral distribution of CSC-features, both on the recurrence after curative resection and on clinical outcome, remains unknown. To address this, we investigated the spatial heterogeneity of CSC-features with the aim of identifying the unique HCC patient subgroups amenable to adjuvant treatment. METHODS We designed a tissue microarray (TMA) from patients who had received liver resection between 2011 and 2017. Tumor specimens were sampled at multiple locations (n = 3-8). EpCAM-positivity was assessed for intensity and proportion by applying a score dividing three groups: (i) negative (E-/-); (ii) heterogeneous (E-/+); and (iii) homogeneous (E+/+). The groups were further analysed with regard to time-to-recurrence (TTR) and recurrence-free-survival (RFS). RESULTS We included 314 tumor spots from 69 patients (76.8% male, median age 66, liver cirrhosis/fibrosis 75.8%). The risk factors were alcohol abuse (26.2%), NASH (13.1%), HBV (15.5%), HCV (17.9%) and others (27.4%), representative of a typical Western cohort. E+/+ patients experienced significantly shorter TTR and RFS compared to E+/- and E-/- patients (TTR 5 vs. 19 months, p = 0.022; RFS 5 vs. 14 vs. 21 months, p = 0.016). Only homogeneous EpCAM-positivity correlated with higher AFP levels (> 400 ng/ml, p = 0.031). CONCLUSIONS Spatial heterogeneity of EpCAM-expression was markedly present in the cohort. Of note, only homogeneous EpCAM-expression correlated significantly with early recurrence, whereas heterogeneous EpCAM-expression was associated with clinical endpoints comparable to EpCAM-negativity. We identified a unique HCC subtype associated with a high risk of tumor recurrence.
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Affiliation(s)
- Jenny Krause
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Casar
- Bioinformatics Core, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thorben W Fründt
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Galaski
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Constantin Schmidt
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Jung
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sören A Weidemann
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Till Krech
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Asmus Heumann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Li
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kornelius Schulze
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
- Mildred Scheel Cancer Career Centre HaTriCS4, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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8
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Kirstein MM, Voigtländer T, Schweitzer N, Hinrichs JB, Marquardt J, Wörns MA, Kloeckner R, Fründt TW, Ittrich H, Wacker F, Rodt T, Manns MP, Wege H, Weinmann A, Vogel A. Transarterial chemoembolization versus sorafenib in patients with hepatocellular carcinoma and extrahepatic disease. United European Gastroenterol J 2018; 6:238-246. [PMID: 29511553 PMCID: PMC5833223 DOI: 10.1177/2050640617716597] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sorafenib is the recommended treatment for advanced hepatocellular carcinoma (HCC), but transarterial chemoembolization (TACE) is performed in individual cases with limited extrahepatic spread. The aim of this study was to compare the outcome of patients with HCC and extrahepatic disease (EHD) treated with sorafenib and TACE. METHODS A total of 172 patients with HCC and EHD treated with sorafenib (n = 98) or TACE (n = 74) at three German referral centers (Hannover, Mainz and Hamburg) were included in this study. In order to reduce selection bias, patients were matched for significant demographic differences using a propensity score analysis. RESULTS Patients with liver cirrhosis, higher extrahepatic tumor burden and/or infiltration of adjacent organs/structures were significantly more often treated with sorafenib. Median overall survival (OS) was similar for sorafenib- and TACE-treated patients (7 versus 8 months, p = 0.312). In a propensity score analysis matched for demographic differences, median OS remained similar with 4 versus 8 months for sorafenib versus TACE (p = 0.613). CONCLUSION Treatment with TACE is not inferior to treatment with sorafenib in patients with limited EHD of HCC. TACE represents an effective therapeutic option in selected patients with EHD.
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Affiliation(s)
- Martha M Kirstein
- Department of Gastroenterology,
Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology,
Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Nora Schweitzer
- Department of Gastroenterology,
Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and
Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jens Marquardt
- Department of Internal Medicine,
University Medical Center of the Johannes Gutenberg University Mainz, Mainz,
Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine,
University Medical Center of the Johannes Gutenberg University Mainz, Mainz,
Germany
| | - Roman Kloeckner
- Department of Diagnostic and
Interventional Radiology, University Medical Center of the Johannes Gutenberg,
Mainz, Germany
| | - Thorben W Fründt
- Department of Internal Medicine,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Ittrich
- Department for Diagnostic and
Interventional Radiology and Nuclear Medicine, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Wacker
- Department of Diagnostic and
Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thomas Rodt
- Department of Diagnostic and
Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology,
Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henning Wege
- Department of Internal Medicine,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arndt Weinmann
- Department of Internal Medicine,
University Medical Center of the Johannes Gutenberg University Mainz, Mainz,
Germany
| | - Arndt Vogel
- Department of Gastroenterology,
Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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9
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Lüth S, Fründt TW, Rösch T, Schlee C, Lohse AW. Prevention of hemolytic uremic syndrome with daily bowel lavage in patients with Shiga toxin-producing enterohemorrhagic Escherichia coli O104:H4 infection. JAMA Intern Med 2014; 174:1003-5. [PMID: 24781800 DOI: 10.1001/jamainternmed.2014.1175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Stefan Lüth
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thorben W Fründt
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schlee
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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