Abstract 182P
Background
Etiology impact on immunotherapy response in advanced hepatocellular carcinoma (HCC) is being debated, with contrasting findings between early and recent post-hoc analyses of IMbrave-150 and metanalyses of clinical trials of PD-1/PD-L1 blockers. As a result, whether the I-line atezolizumab plus bevacizumab (A+B) is equally effective in viral and non-viral patients (pts) remains unclear.
Methods
We retrospectively analyzed data from 885 HCC pts treated with I-line A+B from multiple centers from Europe and Asia, 53.9% having viral and 46.1% non-viral etiology. Baseline clinical and laboratory characteristics were analyzed with uni- and multi-variate models to explore potential differences on overall survival (OS), time to progression (TTP), disease control rate (DCR) and to identify putative prognostic factors in etiology subgroups. Treatment toxicities and access to II-line treatments and outcomes were also compared between etiologies.
Results
No statistically significant differences were found in OS (mOS: viral 15.9mo; non-viral 16.3mo), TTP (mTTP: viral 8.3mo; non-viral 7.2mo), DCR (viral 78.1%; non-viral 80.8%) based on etiology. Independent prognostic factors of survival and progression were mainly shared between viral and non-viral etiologies, including alpha-fetoprotein, aspartate transaminase, neutrophil-to-lymphocyte ratio (NLR) and ALBI score. Exploratory analyses highlighted a possible stronger association of immunological factors, i.e. NLR and eosinophil count, to treatment outcomes in viral pts. The toxicity profile, the access to and type of II-line treatments and their outcome in terms of OS almost overlap in the two etiology subgroups.
Conclusions
A+B efficacy does not vary according to underlying etiology of HCC in a multicenter, real-world population, matching recent post-hoc findings from the IMbrave-150 trial. Preliminary analyses suggest that some prognostic factors differ between viral and non-viral pts, potentially due to biological and immunological differences. Prospective comparative trials stratifying by etiology are warranted to validate these findings and guide clinical practice.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Casadei Gardini: Financial Interests, Personal and Institutional, Advisory Role: MSD, Eisai, Bayer, Bristol Myers Squibb, AstraZeneca, GSK. All other authors have declared no conflicts of interest.