Abstract 226P
Background
Immune checkpoint inhibitor (ICI) is prone to primary or secondary drug resistance, or severe immune-related adverse events (irAE) when treating hepatocellular carcinoma (HCC). This study explored the efficacy and safety of reinitiating ICI treatment in patients with advanced HCC who have developed ICIs resistance or severe irAEs after initial ICI therapy.
Methods
A retrospective analysis was conducted on baseline and follow-up data from patients with advanced HCC who switched to another ICI following resistance or severe irAEs to the initial ICI. Progression-free survival (PFS), objective response rate (ORR), best overall response (BOR), and irAEs were analyzed for both ICI treatments. Patients receiving their first ICI were designated as the ICI-1 cohort, and those undergoing ICI rechallenge were designated as the ICI-2 cohort.
Results
From March 2019 to March 2024, 805 patients with advanced HCC received ICI treatment, among whom 54 patients who switched to another ICI due to resistance or severe irAEs were included in the analysis. These comprised 50 males (92.5%) and 4 females (7.5%), with a median age of 50 years (range: 28-70 years). The median treatment durations for the ICI-1 and ICI-2 cohorts were 5.6 months (range: 1.4-13.3) and 4.2 months (range: 1.4-11.9), respectively. ICI treatment modalities included ICI monotherapy (ICI-1, n=8 (14.8%); ICI-2, n=6 (11.1%)) and ICI combined with targeted therapy (ICI-1, n=46 (85.2%); ICI-2, n=48 (88.9%)). Among the 54 patients, 95.0% (n=52) switched ICI due to disease progression. The median PFS was 5.0 months (95% CI: 4.3-7.0) in ICI-1 cohort and 3.8 months (95% CI: 3.5-7.0) in ICI-2 cohort. The ORRs for the ICI-1 and ICI-2 cohorts were 24.0% and 18.5%, respectively. Four patients achieved objective responses in both the ICI-1 and ICI-2 cohorts, and among the 10 patients with objective responses in the ICI-2 cohort, 2 (20.0%) had experienced disease progression during ICI-1 treatment. Four patients (7.4%) in the ICI-1 cohort and 5 patients (9.3%) in the ICI-2 cohort experienced grade 3 irAEs.
Conclusions
ICI rechallenge in patients with advanced HCC due to resistance or severe irAEs can still benefit some patients, and no new safety signals have been observed.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
the Ethics Committee of Guangxi Medical University Cancer Hospital.
Funding
This work was supported by the Specific Research Project of Guangxi for Research Bases and Talents (GuiKe AD22035057), Guangxi Key Research and Development Plan Project (GuiKe AB24010082), First-class Discipline Innovation-Driven Talent Program of Guangxi Medical University.
Disclosure
All authors have declared no conflicts of interest.