CRAFITY Score Aids in Prognosis of Patients With HCC Undergoing Immunotherapy, TACE

In 2022, Dr. Bernhard Scheiner and colleagues developed the CRAFITY score, based on C-reactive protein and serum alpha-fetoprotein in immunotherapy, to predict prognosis in patients with hepatocellular carcinoma (HCC) undergoing immunotherapy with immune checkpoint blockers.

A new study found that the CRAFITY score can provide an equal prognostic benefit for patients with HCC undergoing transarterial chemoembolization (TACE) combined with PD-L1 inhibitors and molecular targeted therapy (MTT).

From November 2019 to November 2022, researchers enrolled 85 patients with HCC who underwent TACE along with MTT and PD-L1 inhibitors.

Patients who fulfilled no criteria for the CRAFITY score had a score of 0 along with the longest median overall survival (OS). Patients who fulfilled 1 or 2 criteria were given scores of 1 or 2, respectively. Patients were divided into groups based on their CRAFITY score, with 32 patients in group 0, 31 patients in group 1, and 22 patients in group 2.

The primary outcomes were OS and progression-free survival (PFS), while secondary outcomes included tumor response rate and treatment-related adverse events. Cox regression analysis was used to identify factors affecting survival.

The median OS for patients in groups 0, 1, and 2 was 33.4 months (95% CI, 27.1-39.7), 34.5 months (95% CI, 23.1-45.9), and 24.2 months (95% CI, 13.9-39.3), respectively. The PFS rates were 14.1 months (95% CI, 10.0-18.2), 14.1 months (95% CI, 9.0-19.2), and 9.3 months (95% CI, 7.2-11.4) for patients with CRAFITY scores of 0, 1, and 2, respectively.

In patients with CRAFITY scores of 0, 1, and 2, the disease control rates were 94%, 84%, and 73%, respectively (P<.05), and the overall response rates were 78.1%, 67.7%, and 59.1%, respectively (P=.318).

Patients with higher CRAFITY scores had an increased risk of fatigue and grade 3 fever (P<.05). A  CRAFITY score of 2 also served as an independent risk factor for both OS (hazard ratio [HR], 2.610 [1.281- 4.564]; P=.014) and PFS (HR, 2.419 [1.281-4.564]; P=.006).

The CRAFITY score can aid in the efficient prognosis of patients with HCC who are undergoing TACE combined with PD-L1 inhibitors and MTT.