Best Supportive Care Versus Immunotherapy for Patients With Unresectable HCC

A retrospective, multicenter study from Claudia Angela Maria Fulgenzi, MD, and colleagues published in JAMA Oncology compared active anticancer treatment with best supportive care (BSC) for patients with unresectable hepatocellular carcinoma (uHCC) and Child-Pugh class B (CP-B).

Researchers reviewed the data of patients with uHCC and CP-B who underwent treatment with first-line immune checkpoint inhibitor (ICI)-based therapies from September 2017 to December 2022. Data were collected from an international consortium and contrasted with the data of patients with CP-B who received BSC.

Patients in the ICI cohort underwent treatment with first-line systemic therapy with atezolizumab plus bevacizumab (n=141) or nivolumab (n=46). Dr. Fulgenzi and colleagues calculated the propensity score for age, alpha-fetoprotein levels, Child-Pugh score, extrahepatic spread, portal vein tumor thrombosis, cirrhosis, ascites, and baseline Eastern Cooperative Oncology Group (ECOG) performance status.

The study’s primary end point was overall survival (OS) in the inverse probability of treatment weighting (IPTW).

Of the patients in the IPTW group, the median OS rate was notably longer for patients who received ICI (7.50 months; 95% CI, 5.62-11.15) than those in the BSC cohort (4.04 months; 95% CI, 3.03-5.03).

Through multivariable analysis, a connection was discovered between ICI exposure and a 50% reduction in the risk of death (95% CI, 0.35-0.86; P<.001). Researchers also found an association between portal vein tumor thrombosis, an ECOG performance status score higher than 1, and alpha-fetoprotein levels of 400 ng/mL or greater and a higher risk of death.

“The results of this case series provide comparative evidence of improved survival in association with ICI treatment compared with BSC in patients with uHCC with CP-B liver dysfunction,” Dr. Fulgenzi and colleagues wrote.