Simplified BALAD (BALAD-S) Score as a Guide for First-Line Immune Checkpoint Inhibitor Selection for Unresectable...

Area of Science:

• Hepatocellular Carcinoma Research
• Immunotherapy Biomarkers
• Clinical Outcome Prediction

Background:

• First-line immune checkpoint inhibitor (ICI) regimens like atezolizumab plus bevacizumab (Atez/Bev) and durvalumab plus tremelimumab (Dur/Tre) are standard for unresectable hepatocellular carcinoma (uHCC).
• Limited biomarkers exist to guide the selection between these effective ICI-based treatments.
• The simplified BALAD-based score (BALAD-S) was investigated as a potential predictive biomarker.

Purpose of the Study:

• To evaluate the association between the simplified BALAD-based score (BALAD-S) and differential treatment outcomes in patients with unresectable hepatocellular carcinoma (uHCC).
• To determine if BALAD-S can help stratify patients for first-line immune checkpoint inhibitor (ICI)-based regimens.

Main Methods:

• A multicenter retrospective study of 752 Japanese patients with uHCC receiving first-line Atez/Bev or Dur/Tre.
• BALAD-S was calculated using bilirubin, albumin, AFP, AFP-L3, and des-γ-carboxy prothrombin.
• Patients were stratified into BALAD-S low (≤ 2) and high (≥ 3) groups to compare treatment response, progression-free survival (PFS), and overall survival (OS).

Main Results:

• In the BALAD-S low group, Atez/Bev demonstrated significantly longer PFS and OS compared to Dur/Tre.
• In the BALAD-S high group, OS was significantly longer with Dur/Tre than Atez/Bev, while PFS did not differ significantly.
• A significant interaction was observed between BALAD-S category and treatment choice, indicating differential treatment effects based on the score.

Conclusions:

• Treatment outcomes for Atez/Bev and Dur/Tre regimens in uHCC vary significantly based on the BALAD-S score.
• The BALAD-S score shows promise as a stratification marker to guide the selection of first-line ICI-based therapies in uHCC.
• Further validation is needed for BALAD-S to confirm its utility in clinical decision-making for uHCC treatment.