Abstract 236P
Background
Immune checkpoint inhibitors (ICIs) and its combination strategies have been proven as a promising approach in the treatment of advanced HCC. However, a large proportion of patients will develop resistance in certain stage of treatment. Resistance to ICI-therapies can be classified into primary resistance and acquired resistance. Although frequently noticed, the characteristics of primary and acquired resistance in HCC immune-therapy, as well as their impact to disease prognosis, are still vague.
Methods
Unresectable HCC patients treated with ICI and Lenvatinib were included in this retrospective study. All patients’ baseline characteristics, tumor status changes during treatment and outcomes were recorded. The primary endpoint was overall survival (OS). The second endpoint was post-progression survival (PPS). Single- and multiple-variate Cox regression analysis were used to analyze the prognostic factors for overall survival.
Results
A total of 201 patients with unresectable HCC receiving treatment with ICI and Lenvatinib were examined. Among them, 161 patients developed resistance. The overall resistance rate was 80.1%. The rate of primary resistance was 38.3%. the rate of acquired resistance was 41.8%. The median time to acquired resistance was 9.67 months. Patients with acquired resistance have better general condition, liver function and less tumor burden than ones with primary resistance. Patients with acquired resistance have significantly better prognosis (mOS 26.3m vs. 8.9m) than ones with primary resistance. Developing primary resistance was identified as a strong independent risk factor (HR, 4.10; P<0.001). Child-Pugh group B, ECOG performance status ≥1 and PD were identified as independent risk factors in patients with primary resistance. Only max tumor size ≥5 cm was identified as independent risk factor in patients with acquired resistance.
Conclusions
Both primary and acquired resistance are common in uHCC immune-therapy combination treatment. Primary and acquired resistance have strong impact toward overall survival. There exists significant difference in risk factors for survival in uHCC patients with primary and acquired resistance.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.