Abstract 1005P
Background
Hepatocellular carcinoma (HCC) is a primary liver malignancy. Kinase inhibitors are standard of care (SoC) for metastatic HCC with median overall survival (mOS) of <13 months. This systematic review was aimed to elucidate immune checkpoint inhibitor (ICI) treatment outcomes in patients with advanced HCC and compare to current SoC.
Methods
Clinical studies were identified through PUBMED, Scopus, Embase, ASCO and ESMO databases. Studies evaluating ICIs in patients with HCC and reporting efficacy outcomes were considered as eligible. Elucidation of objective response rate (ORR) was primary endpoint and OS was secondary endpoint. Data analysis was performed by employing fixed and random effects model depending on study heterogeneity evaluating by I2 statistic. STATA v16 software was used for statistical considerations.
Results
We have identified 14 eligible clinical studies with overall of 1697 patients. ICIs as a monotherapy were examined in 8 studies, whereas the remaining six used ICIs in combination with other drugs. The mean ORR for ICIs as a monotherapy was 14% (95% CI, 12.3 to 15.9) which is non-inferior to SoC sorafenib. The mean ORR for ICIs used in combination was 25.2% (95% CI, 23.5 to 27) with pembrolizumab + lenvatinib reached the highest ORR (44.8%; 95% CI, 37.6 to 52.1) among all observed studies. This regimen was used as a first line (1L) approach. Atezolizumab + bevacizumab showed the second highest ORR (34%; 95% CI 21 to 42) among studies determining 1L ICI treatment approach. Interestingly, nivolumab alone resulted in 9.8 mOS in advanced HCC patients with Child-Pugh class B. Finally, with regard to 2L approach nivolumab with ipilimumab showed the highest ORR (32%, 95% CI 27 to 35).
Conclusions
This study suggests that (1) pembrolizumab with lenvatinib and (2) atezolizumab with bevacizumab may be superior (ORR) to SoC 1L sorafenib in advanced HCC patients. Nivolumab with ipilimumab provided higher OS and ORR in sorafenib progressors as compared to 2L SoC regorafenib. Of note, many of the studies included were only available in abstract form and final reporting is pending. Nevertheless, our results raise hope that ICIs may present a potentially superior alternative to SoC in advanced HCC.
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.