Affiliation:
1. Division of Gastroenterology and Hepatology Department of Internal Medicine III Medical University of Vienna Vienna Austria
2. Liver Cancer (HCC) Study Group Vienna Division of Gastroenterology and Hepatology Department of Internal Medicine III Medical University of Vienna Vienna Austria
3. Department of Digestive Oncology APHP.Nord Hôpital Beaujon Clichy France
4. Department of Radiology APHP.Nord Hôpital Beaujon Clichy France
5. Division of Hematology and Oncology Department of Internal Medicine III Hanusch Hospital Vienna Austria
6. Université Paris Cité CRI INSERM U1149 Paris France
Abstract
AbstractBackground and AimsDeterioration of liver function is a leading cause of death in patients with advanced hepatocellular carcinoma (HCC). We evaluated the impact of immune checkpoint inhibitor (ICI)‐treatment on liver function and outcomes.MethodHCC patients receiving ICIs or sorafenib between 04/2003 and 05/2024 were included. Liver function (assessed by Child‐Pugh score [CPS]) was evaluated at the start of ICI‐treatment (baseline, BL) and 3 and 6 months thereafter. A ≥1 point change in CPS was defined as deterioration (−) or improvement (+), while equal CPS points were defined as stable (=).ResultsOverall, 182 ICI‐treated patients (66.8 ± 11.8 years; cirrhosis: n = 134, 74%) were included. At BL, median CPS was 5 (IQR: 5–6; CPS‐A: 147, 81%). After 3 months, liver function improved/stabilized in 102 (56%) and deteriorated in 61 (34%) patients, while 19 (10%) patients deceased/had missing follow‐up (d/noFU). Comparable results were observed at 6 months (+/=: n = 82, 45%; −: n = 55, 30%; d/noFU: n = 45, 25%). In contrast, 54 (34%) and 33 (21%) out of 160 sorafenib patients achieved improvement/stabilization at 3 and 6 months, respectively. Radiological response was linked to CPS improvement/stabilization at 6 months (responders vs. non‐responders, 73% vs. 50%; p = 0.007). CPS improvement/stabilization at 6 months was associated with better overall survival following landmark analysis (6 months: +/=: 28.4 [95% CI: 18.7–38.1] versus −: 14.2 [95% CI: 10.3–18.2] months; p < 0.001). Of 35 ICI‐patients with CPS‐B at BL, improvement/stabilization occurred in 16 (46%) patients, while 19 (54%) patients deteriorated/d/noFU at 3 months. Comparable results were observed at 6 months (CPS +/=: 14, 40%, −: 8, 23%). Importantly, 6/35 (17%) and 9/35 (26%) patients improved from CPS‐B to CPS‐A at 3 and 6 months.ConclusionRadiological response to ICI‐treatment was associated with stabilization or improvement in liver function, which correlated with improved survival, even in patients with Child‐Pugh class B at baseline.