Prognosis of patients with hepatocellular carcinoma treated with immunotherapy: development and validation of the CRAFITY score

Medientyp: E-Artikel

Titel: Prognosis of patients with hepatocellular carcinoma treated with immunotherapy : development and validation of the CRAFITY score

Beteiligte: Scheiner, Bernhard [Verfasser:in]; Pomej, Katharina [Verfasser:in]; Kirstein, Martha M. [Verfasser:in]; Hucke, Florian [Verfasser:in]; Finkelmeier, Fabian [Verfasser:in]; Waidmann, Oliver [Verfasser:in]; Himmelsbach, Vera [Verfasser:in]; Schulze, Kornelius [Verfasser:in]; von Felden, Johann [Verfasser:in]; Fründt, Thorben W. [Verfasser:in]; Stadler, Marc [Verfasser:in]; Heinzl, Harald [Verfasser:in]; Shmanko, Kateryna [Verfasser:in]; Spahn, Stephan [Verfasser:in]; Radu, Pompilia [Verfasser:in]; Siebenhüner, Alexander R. [Verfasser:in]; Mertens, Joachim C. [Verfasser:in]; Rahbari, Nuh Nabi [Verfasser:in]; Kütting, Fabian [Verfasser:in]; Waldschmidt, Dirk-Thomas [Verfasser:in]; Ebert, Matthias [Verfasser:in]; Teufel, Andreas [Verfasser:in]; De Dosso, Sara [Verfasser:in]; Pinato, David J. [Verfasser:in]; Pressiani, Tiziana [Verfasser:in]; Meischl, Tobias [Verfasser:in]; Balcar, Lorenz [Verfasser:in]; Müller, Christian [Verfasser:in]; Mandorfer, Mattias [Verfasser:in]; Reiberger, Thomas [Verfasser:in]; Trauner, Michael [Verfasser:in]; Personeni, Nicola [Verfasser:in]; Rimassa, Lorenza [Verfasser:in]; Bitzer, Michael [Verfasser:in]; Trojan, Jörg [Verfasser:in]; Weinmann, Arndt [Verfasser:in]; Wege, Henning [Verfasser:in]; Dufour, Jean-François [Verfasser:in]; Peck-Radosavljevic, Markus [Verfasser:in]; Vogel, Arndt [Verfasser:in]; Pinter, Matthias [Verfasser:in]

Erschienen: February 2022

Sprache: Englisch

DOI: 10.1016/j.jhep.2021.09.035

Identifikator:

Schlagwörter: alpha-fetoprotein ; C-reactive protein ; immune checkpoint inhibitor ; liver cancer

Entstehung:

Anmerkungen: Online verfügbar: 12. Oktober 2021, Artikelversion: 14. Januar 2022

Beschreibung: 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.

Zugangsstatus: Freier Zugang

Nur in Feld suchen:

Zuletzt gesuchte Begriffe: