ESMO Asia Congress 2022

Abstract 127P

Background

There is no widely used prognostic tool to demonstrate the benefit of oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX4) in patients with advanced hepatocellular carcinoma (HCC). We aimed to establish the prognostic score and demonstrate the real-world efficacy of FOLFOX4 in Thai patients.

Methods

Between August 2017 and December 2021, 58 patients with HCC treated with FOLFOX4 were identified. Efficacies of FOLFOX4, including overall survival (OS), progression-free survival (PFS), and objective response rate (ORR), were assessed. The prognostic score was constructed by stepwise cox proportional hazards regression combined with clinical experience to select variables for the best model.

Results

44 patients (76%) received FOLFOX4 as first-line systemic therapy. The efficacies of FOLFOX4 in the entire cohort were ORR of 8.6% and clinical benefit rate (CBR) of 29.3%. The median OS and PFS were 4.8 and 3.7 months, respectively. Four variables were included in the new prognostic score to predict 6-month overall survival based on their clinical relevance: L, the presence of lung metastasis; A, alcoholic cirrhosis; B, elevated total bilirubin; and S, sorafenib naive. The new prognostic "LABS" score classified all patients into low-, intermediate-, and high-risk groups, demonstrating the median OS of 9.3, 4.2, and 2.1 months, respectively (P<0.0001). The C-index and area under receiver operating characteristic curve of this score were 0.71 and 0.73, respectively.

Conclusions

The FOLFOX4 regimen showed comparable ORR, PFS, and OS efficacy to previous reports. The proposed prognostic “LABS” score clearly discriminated patients who would have the benefit from FOLFOX4. Therefore, we suggest that FOLFOX4 should be considered as one of the options for those who cannot approach immunotherapy and targeted therapy, particularly with a low-risk score. However, this model should be further evaluated in the larger cohorts.