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Immune Checkpoint Inhibitors for Child-Pugh Class B Advanced Hepatocellular Carcinoma: A Systematic Review and
Enrui Xie1, Yee Hui Yeo2, Bernhard Scheiner3,4
1Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
JAMA Oncology
|August 24, 2023
Summary
Immune checkpoint inhibitors (ICIs) show comparable safety but lower response rates and survival in advanced hepatocellular carcinoma (HCC) patients with Child-Pugh B liver function. Further research is needed for this population.
Area of Science:
- Hepatocellular Carcinoma (HCC) Treatment
- Immunotherapy and Oncology
- Liver Function Assessment
Background:
- Immune checkpoint inhibitors (ICIs) are a key treatment for advanced hepatocellular carcinoma (HCC).
- Limited data exist on ICI efficacy and safety in HCC patients with impaired liver function (Child-Pugh B).
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of ICI treatment in advanced HCC patients with Child-Pugh B liver function.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials, cohort studies, and single-group studies.
- Searched PubMed, Embase, Web of Science, and Cochrane Library up to June 15, 2022.
- Analyzed objective response rate (ORR), overall survival (OS), and treatment-related adverse events (trAEs).
Main Results:
- Pooled analysis of 22 studies (699 Child-Pugh B, 2114 Child-Pugh A patients) showed ORR of 14% and median OS of 5.49 months for Child-Pugh B patients.
- Child-Pugh B patients had lower ORR and disease control rate (DCR) compared to Child-Pugh A patients.
- ICI treatment was not associated with increased trAEs in Child-Pugh B patients, but worse OS was observed.
Conclusions:
- ICI treatment for advanced HCC in Child-Pugh B patients demonstrates comparable safety but inferior survival outcomes compared to Child-Pugh A patients.
- Radiologic responses were observed, but overall survival remains a concern in patients with poorer liver function.
- Further investigation is warranted to optimize ICI effectiveness in this specific patient population.
