Curative Treatment after Immunotherapy Leads to Excellent Outcomes in Patients with Hepatocellular Carcinoma

The high response rates observed with immunotherapy may allow downstaging to curative treatment in hepatocellular carcinoma (HCC). We aimed to investigate the factors associated with curative treatment receipt after immunotherapy and its outcomes.

HCC patients who received immunotherapy as a first-line treatment during 2017-2020 were identified from the US National Cancer Database. Patients were classified into two groups: immunotherapy with subsequent curative treatment (resection, transplantation, and local ablation) and immunotherapy without curative treatment. Multivariable Cox regression analysis was performed to determine factors associated with OS, followed by propensity score (PS) matching and inverse probability of treatment weighting (IPTW)-adjusted analysis.

Of the 4,329 HCC patients (median age 66 years, 81% male, 33% T4, 22% N1, and 32% M1 stage) who received immunotherapy as a first-line treatment, 138 (3.2%) received subsequent curative treatment after immunotherapy, with a median interval of 3.0 months between the two treatments. Curative treatment receipt was independently associated with care in an academic health system (odds ratio: 3.40, 95% CI: 1.68-7.38). OS was significantly longer in those with curative treatment conversion (hazard ratio [HR]: 0.15, 95% CI: 0.11-0.22), including after PS matching (HR: 0.20, 95% CI: 0.13-0.30) and IPTW-adjusted (HR: 0.19, 95% CI: 0.11-0.31) analyses. The median survival was not reached versus 10 months for those with and without subsequent curative treatment.

Curative treatment conversion after immunotherapy was infrequent but was associated with significantly improved survival. Care at an academic center increases the probability of receiving subsequent curative treatment and favorable outcomes.