KEY TAKEAWAYS
- The IMbrave150 phase 3 trial aimed to investigate etiological impact on AB-treated HCC patients, consolidating with prior lenvatinib studies.
- The result concluded that AB showed efficacy across HCC, but distinct biology needs deeper study.
The influence of etiology on immunotherapy response in advanced hepatocellular carcinoma (HCC) has suggested that PD-1/PD-L1 blockade benefited viral HCC patients (pts) more than non-viral cases. The recent IMbrave-150 trial analysis revealed that Atezolizumab plus Bevacizumab (AB) showed consistent efficacy across viral and non-viral groups.
Herein, Federico Rossari and his research group explored the impact of etiology on HCC pts treated with AB in a real-world context, aiming to consolidate and align these findings with previous comparisons involving lenvatinib.
In the interventional study, 885 HCC pts, who were treated with initial AB across Eastern and Western countries, comprising 53.9% with viral and 46.1% with non-viral etiology were analyzed. The baseline clinical and laboratory features were scrutinized using uni- and multi-variate models to evaluate etiology’s influence on overall survival (OS), time to progression (TTP), response rates, and to identify prognostic factors within etiology subgroups.
The result showed no statistically significant disparities in OS (mOS: viral 15.9 months; non-viral 16.3 months), TTP (mTTP: viral 8.3 months; non-viral 7.2 months), and response rates based on etiology. The distinct prognostic factors were observed between the two groups.
Patients with viral etiology, there was a positive correlation between eosinophil count and OS, whereas among non-viral pts, AST and ALP levels exhibited a significant association with OS. Prognostic indicators for both groups included AFP, NLR, and ALBI score. The toxicity profile of AB demonstrated considerable overlap in the two etiology subgroups.
The study concluded that the underlying cause does not heavily influence the outcomes of HCC pts undergoing treatment with AB. Certain prognostic factors show distinctions between viral and non-viral pts, with immunological factors primarily linked to the former and metabolic factors to the latter.
This underscored potential biological variations. These differences might explain the varied outcomes observed in comparative studies between AB and lenvatinib in different etiology subgroups. To validate these findings and provide guidance for clinical practice, it is imperative to conduct prospective and comparative trials that stratify pts based on etiology.
This study is sponsored by Hoffmann-La Roche.
Source: https://cslide.ctimeetingtech.com/asia2023/attendee/confcal/show/session/78
Clinical Trial: https://clinicaltrials.gov/study/NCT03434379
Rossari F, Tada T, Shimose S, et al. “Disease etiology impact on outcomes of hepatocellular carcinoma patients treated with atezolizumab plus bevacizumab: A real-world, multicenter study.” presented at ESMO ASIA CONGRESS. (Abstract: 185P).
