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Deterioration of liver function and aging disturb sequential systemic therapy for unresectable hepatocellular carcinoma.

ABSTRACT: This study aimed to investigate the clinical characteristics of patients with unresectable hepatocellular carcinoma (HCC), who were eligible for sequential systemic therapy. We evaluated 365 patients with HCC who underwent systemic therapy after 2017. The overall survival (OS) was 13.7 months, 19.2 months, and 35.6 months in the first-line, second-line, and third-line or later therapy groups, respectively. Multivariate analysis revealed that the modified-albumin-bilirubin (m-ALBI) grade, macrovascular invasion, extrahepatic spread, discontinuation due to adverse events (AEs), and sequential therapy were independent factors for OS. At the end of each therapy, the ALBI score was significantly worse among patients with discontinuation due to AEs than among those without. The conversion rate to second-line and third-line therapy among patients with discontinuation due to AEs was significantly lower than that among patients without (30.4% vs. 69.2%, p < 0.001; 6.7% vs. 58.3%; p < 0.001, respectively). In the decision tree analysis, m-ALBI grade 1 or 2a and non-advanced age were selected splitting variables, respectively, for sequential systemic therapy. In conclusion, sequential therapy prolonged the OS of unresectable HCC. Additionally, good hepatic function and non-advanced age were clinically eligible characteristics for sequential systemic therapy.

SUBMITTER: Shimose S

PROVIDER: S-EPMC9554046 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Deterioration of liver function and aging disturb sequential systemic therapy for unresectable hepatocellular carcinoma.

Shimose Shigeo S Hiraoka Atsushi A Tanaka Masatoshi M Iwamoto Hideki H Tanaka Takaaki T Noguchi Kazunori K Aino Hajime H Yamaguchi Taizo T Itano Satoshi S Suga Hideya H Niizeki Takashi T Moriyama Etsuko E Shirono Tomotake T Noda Yu Y Kamachi Naoki N Okamura Shusuke S Nakano Masahito M Kawaguchi Takumi T Kuromatsu Ryoko R Koga Hironori H Torimura Takuji T

Scientific reports 20221011 1

This study aimed to investigate the clinical characteristics of patients with unresectable hepatocellular carcinoma (HCC), who were eligible for sequential systemic therapy. We evaluated 365 patients with HCC who underwent systemic therapy after 2017. The overall survival (OS) was 13.7 months, 19.2 months, and 35.6 months in the first-line, second-line, and third-line or later therapy groups, respectively. Multivariate analysis revealed that the modified-albumin-bilirubin (m-ALBI) grade, macrova ...[more]

PMID: 36220865

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Project description:Background & aimsSorafenib has been the standard of care for patients with advanced hepatocellular carcinoma and although immunotherapeutic approaches are now challenging this position, it retains an advantage in HCV-seropositive patients. We aimed to quantify the rate of tumour progression in patients receiving sorafenib and relate this figure to survival, both overall, and according to viral status.MethodsUsing serial data from an international clinical trial we applied a joint model to combine survival and progression over time in order to estimate the rate of tumour growth as assessed by tumour burden and serum alpha-fetoprotein, and the impact of treatment on liver function.ResultsHigh tumour burden at baseline was associated with an increased risk of death. In patients still alive at the end of the study, the progression in relation to tumour burden was very low compared to those who died within the study. Overall, the change in mean tumour burden was 0.12 mm per day or an absolute growth rate of 3.6 mm/month. Median doubling time was 665 days. For those who progressed above 0.12 mm per day or the 12% rate, median survival was 234 days compared to 384 days if the rate was below 12%. Tumour growth rate and serum alpha-fetoprotein rise were significantly lower in those who were HCV seropositive as was the rate of decline in liver function. These results were replicated in 2 independent patient groups.ConclusionOur analysis suggests that sorafenib treatment is associated with improved survival in patients with advanced hepatocellular carcinoma mainly by decreasing the rate of tumour growth and liver function deterioration among patients with HCV infection.Lay summaryAmong patients receiving sorafenib for advanced hepatocellular carcinoma the rate of tumour growth (as assessed by changes in tumour size and the biomarker alpha-fetoprotein) and the deterioration of liver function is less in those who have the hepatitis C virus, than in those who do not.

Dataset Information

Deterioration of liver function and aging disturb sequential systemic therapy for unresectable hepatocellular carcinoma.

Publications

Deterioration of liver function and aging disturb sequential systemic therapy for unresectable hepatocellular carcinoma.

Similar Datasets

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