PsA: Real-world safety and efficacy of TNF inhibitors and ustekinumab are comparable

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Key clinical point: In a real-world cohort of patients with psoriatic arthritis (PsA), achievement of treatment targets was similar after 6 months of treatment with ustekinumab or tumor necrosis factor (TNF) inhibitors.

Major finding: After 6 months of treatment, the proportion of patients achieving clinical Disease Activity Index for PsA (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.46-1.15), low disease activity (LDA; OR, 0.74; 95% CI, 0.53-1.04), minimal disease activity (OR, 0.87; 95% CI, 0.61-1.25), and very LDA (OR, 0.74; 95% CI, 0.42-1.30) was not significantly different in ustekinumab vs TNF inhibitor groups. Both the groups reported similar adverse and serious adverse events.

Study details: Findings are from an analysis of 868 patients with PsA from the observational PsABio study, who were treated with first-line to third-line ustekinumab or TNF inhibitors.

Disclosures: PsABio study was sponsored by Janssen. The authors including the lead author reported receiving grants/research support and/or personal fees from various sources including Janssen. W Noël, P Bergmans, and E Theander reported being full-time employees of Janssen.

Source: Smolen JS et al. Ann Rheum Dis. 2021 Jun 23. doi: 10.1136/annrheumdis-2021-220263.

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Key clinical point: In a real-world cohort of patients with psoriatic arthritis (PsA), achievement of treatment targets was similar after 6 months of treatment with ustekinumab or tumor necrosis factor (TNF) inhibitors.

Major finding: After 6 months of treatment, the proportion of patients achieving clinical Disease Activity Index for PsA (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.46-1.15), low disease activity (LDA; OR, 0.74; 95% CI, 0.53-1.04), minimal disease activity (OR, 0.87; 95% CI, 0.61-1.25), and very LDA (OR, 0.74; 95% CI, 0.42-1.30) was not significantly different in ustekinumab vs TNF inhibitor groups. Both the groups reported similar adverse and serious adverse events.

Study details: Findings are from an analysis of 868 patients with PsA from the observational PsABio study, who were treated with first-line to third-line ustekinumab or TNF inhibitors.

Disclosures: PsABio study was sponsored by Janssen. The authors including the lead author reported receiving grants/research support and/or personal fees from various sources including Janssen. W Noël, P Bergmans, and E Theander reported being full-time employees of Janssen.

Source: Smolen JS et al. Ann Rheum Dis. 2021 Jun 23. doi: 10.1136/annrheumdis-2021-220263.

Key clinical point: In a real-world cohort of patients with psoriatic arthritis (PsA), achievement of treatment targets was similar after 6 months of treatment with ustekinumab or tumor necrosis factor (TNF) inhibitors.

Major finding: After 6 months of treatment, the proportion of patients achieving clinical Disease Activity Index for PsA (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.46-1.15), low disease activity (LDA; OR, 0.74; 95% CI, 0.53-1.04), minimal disease activity (OR, 0.87; 95% CI, 0.61-1.25), and very LDA (OR, 0.74; 95% CI, 0.42-1.30) was not significantly different in ustekinumab vs TNF inhibitor groups. Both the groups reported similar adverse and serious adverse events.

Study details: Findings are from an analysis of 868 patients with PsA from the observational PsABio study, who were treated with first-line to third-line ustekinumab or TNF inhibitors.

Disclosures: PsABio study was sponsored by Janssen. The authors including the lead author reported receiving grants/research support and/or personal fees from various sources including Janssen. W Noël, P Bergmans, and E Theander reported being full-time employees of Janssen.

Source: Smolen JS et al. Ann Rheum Dis. 2021 Jun 23. doi: 10.1136/annrheumdis-2021-220263.

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Ultrasonography can help assess PsA disease activity, regardless of coexisting FMS

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Key clinical point: The composite ultrasonography scores showed a significantly greater value for assessment of disease activity than clinical scores in patients with psoriatic arthritis (PsA) with coexisting fibromyalgia syndrome (FMS).

Major finding: Patients with coexisting PsA and FMS vs those without FMS had higher scores for several disease activity indices, including Composite Psoriatic Disease Activity Index, Disease Activity for PsA, and PsA Disease Activity Score (P less than .001). However, both groups had similar total ultrasonographic scores regardless of FMS (P = .68). A significant association was observed between FMS and higher scores on clinical activity indices (P less than .001) but not with the ultrasonography score.

Study details: The data come from a prospective study of 156 patients with PsA who were categorized into those with (n=42) and without (n=114) FMS.

Disclosures: No specific funding or conflicts of interest were reported.

Source: Polachek A et al. Ann Rheum Dis. 2021 Jul 2. doi: 10.1136/annrheumdis-2021-220562.

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Key clinical point: The composite ultrasonography scores showed a significantly greater value for assessment of disease activity than clinical scores in patients with psoriatic arthritis (PsA) with coexisting fibromyalgia syndrome (FMS).

Major finding: Patients with coexisting PsA and FMS vs those without FMS had higher scores for several disease activity indices, including Composite Psoriatic Disease Activity Index, Disease Activity for PsA, and PsA Disease Activity Score (P less than .001). However, both groups had similar total ultrasonographic scores regardless of FMS (P = .68). A significant association was observed between FMS and higher scores on clinical activity indices (P less than .001) but not with the ultrasonography score.

Study details: The data come from a prospective study of 156 patients with PsA who were categorized into those with (n=42) and without (n=114) FMS.

Disclosures: No specific funding or conflicts of interest were reported.

Source: Polachek A et al. Ann Rheum Dis. 2021 Jul 2. doi: 10.1136/annrheumdis-2021-220562.

Key clinical point: The composite ultrasonography scores showed a significantly greater value for assessment of disease activity than clinical scores in patients with psoriatic arthritis (PsA) with coexisting fibromyalgia syndrome (FMS).

Major finding: Patients with coexisting PsA and FMS vs those without FMS had higher scores for several disease activity indices, including Composite Psoriatic Disease Activity Index, Disease Activity for PsA, and PsA Disease Activity Score (P less than .001). However, both groups had similar total ultrasonographic scores regardless of FMS (P = .68). A significant association was observed between FMS and higher scores on clinical activity indices (P less than .001) but not with the ultrasonography score.

Study details: The data come from a prospective study of 156 patients with PsA who were categorized into those with (n=42) and without (n=114) FMS.

Disclosures: No specific funding or conflicts of interest were reported.

Source: Polachek A et al. Ann Rheum Dis. 2021 Jul 2. doi: 10.1136/annrheumdis-2021-220562.

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Guselkumab safe and effective for early PsA in real-life setting

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Key clinical point: Findings from this real-life cohort of patients with early psoriatic arthritis (PsA) confirm the safety and efficacy of guselkumab on peripheral and axial manifestations.

Major finding: After 12 months of guselkumab treatment, the mean Patient Global Assessment (P less than .0001), Visual Analogue Scale of Pain (P less than .001), and Disease Activity Score of PsA (P less than .0001) decreased significantly. Inflammatory low back pain disappeared as early as 24 weeks in all patients with concomitant axial disease. Low disease activity and remission were achieved by 65% and 35% of patients, respectively. No adverse events were reported.

Study details: The data come from an observational study involving 24 patients with early PsA who initiated therapy with guselkumab for severe skin involvement.

Disclosures: No specific funding was received for this study. The authors declared no conflicts of interest.

 Source: Pantano I et al. Rheumatology (Oxford). 2021 Jun 21. doi: 10.1093/rheumatology/keab509.

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Key clinical point: Findings from this real-life cohort of patients with early psoriatic arthritis (PsA) confirm the safety and efficacy of guselkumab on peripheral and axial manifestations.

Major finding: After 12 months of guselkumab treatment, the mean Patient Global Assessment (P less than .0001), Visual Analogue Scale of Pain (P less than .001), and Disease Activity Score of PsA (P less than .0001) decreased significantly. Inflammatory low back pain disappeared as early as 24 weeks in all patients with concomitant axial disease. Low disease activity and remission were achieved by 65% and 35% of patients, respectively. No adverse events were reported.

Study details: The data come from an observational study involving 24 patients with early PsA who initiated therapy with guselkumab for severe skin involvement.

Disclosures: No specific funding was received for this study. The authors declared no conflicts of interest.

 Source: Pantano I et al. Rheumatology (Oxford). 2021 Jun 21. doi: 10.1093/rheumatology/keab509.

Key clinical point: Findings from this real-life cohort of patients with early psoriatic arthritis (PsA) confirm the safety and efficacy of guselkumab on peripheral and axial manifestations.

Major finding: After 12 months of guselkumab treatment, the mean Patient Global Assessment (P less than .0001), Visual Analogue Scale of Pain (P less than .001), and Disease Activity Score of PsA (P less than .0001) decreased significantly. Inflammatory low back pain disappeared as early as 24 weeks in all patients with concomitant axial disease. Low disease activity and remission were achieved by 65% and 35% of patients, respectively. No adverse events were reported.

Study details: The data come from an observational study involving 24 patients with early PsA who initiated therapy with guselkumab for severe skin involvement.

Disclosures: No specific funding was received for this study. The authors declared no conflicts of interest.

 Source: Pantano I et al. Rheumatology (Oxford). 2021 Jun 21. doi: 10.1093/rheumatology/keab509.

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Nail involvement in PsA may help identify patients at high risk

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Key clinical point: Patients with psoriatic arthritis (PsA) with vs without nail involvement had higher rates of carotid plaque (CP) and carotid intima-media thickness (cIMT). Additionally, nail involvement in PsA was independently associated with CP risk.

Major finding: Patients with vs without nail involvement showed a higher prevalence of CP (53.1% vs 25.0%; P = .021) and cIMT (0.85 vs 0.59 mm; P = .026). The nail involvement was an independent risk factor for the presence of CP (odds ratio, 6.64; P = .006).

Study details: Findings are from a cross-sectional, observational study involving 64 patients with PsA. Patients with nail involvement were matched by age, gender, and type 2 diabetes mellitus diagnosis to those without nail involvement.

Disclosures: No specific funding or conflicts of interest were declared.

Source: Colunga-Pedraza IJ et al. Ann Rheum Dis. 2021 Jun 24. doi: 10.1136/annrheumdis-2021-220782.

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Key clinical point: Patients with psoriatic arthritis (PsA) with vs without nail involvement had higher rates of carotid plaque (CP) and carotid intima-media thickness (cIMT). Additionally, nail involvement in PsA was independently associated with CP risk.

Major finding: Patients with vs without nail involvement showed a higher prevalence of CP (53.1% vs 25.0%; P = .021) and cIMT (0.85 vs 0.59 mm; P = .026). The nail involvement was an independent risk factor for the presence of CP (odds ratio, 6.64; P = .006).

Study details: Findings are from a cross-sectional, observational study involving 64 patients with PsA. Patients with nail involvement were matched by age, gender, and type 2 diabetes mellitus diagnosis to those without nail involvement.

Disclosures: No specific funding or conflicts of interest were declared.

Source: Colunga-Pedraza IJ et al. Ann Rheum Dis. 2021 Jun 24. doi: 10.1136/annrheumdis-2021-220782.

Key clinical point: Patients with psoriatic arthritis (PsA) with vs without nail involvement had higher rates of carotid plaque (CP) and carotid intima-media thickness (cIMT). Additionally, nail involvement in PsA was independently associated with CP risk.

Major finding: Patients with vs without nail involvement showed a higher prevalence of CP (53.1% vs 25.0%; P = .021) and cIMT (0.85 vs 0.59 mm; P = .026). The nail involvement was an independent risk factor for the presence of CP (odds ratio, 6.64; P = .006).

Study details: Findings are from a cross-sectional, observational study involving 64 patients with PsA. Patients with nail involvement were matched by age, gender, and type 2 diabetes mellitus diagnosis to those without nail involvement.

Disclosures: No specific funding or conflicts of interest were declared.

Source: Colunga-Pedraza IJ et al. Ann Rheum Dis. 2021 Jun 24. doi: 10.1136/annrheumdis-2021-220782.

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Guselkumab effective for PsA patients having axial symptoms

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Key clinical point: Patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis treated with guselkumab every 4 weeks (Q4) or every 8 weeks (Q8) had greater mean improvements in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) score than placebo.

Major finding: At week 24, guselkumab Q4 and Q8 groups vs placebo showed higher least-squares mean changes in BASDAI (−2.7 and −2.7 vs −1.3; P less than .0001) and ASDAS (−1.4 and −1.4 vs −0.7; P less than .0001) scores, which were maintained until week 52.

Study details: This was a post hoc analysis of 2 DISCOVER studies including 312 patients with PsA with imaging-confirmed sacroiliitis who were randomly assigned to either placebo (n=118), guselkumab Q4 (n=103), or Q8 (n=91).

Disclosures: This study was funded by Janssen Research & Development LLC. The authors including the lead author reported grants and/or personal fees from various sources. Some of the authors declared being employees of Janssen Scientific Affairs LLC and Janssen Global Services LLC. Ten authors owned shares/stock options in Johnson & Johnson.

Source: Mease PJ et al. Lancet Rheumatol. 2021 Jun 29. doi: 10.1016/S2665-9913(21)00105-3.

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Key clinical point: Patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis treated with guselkumab every 4 weeks (Q4) or every 8 weeks (Q8) had greater mean improvements in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) score than placebo.

Major finding: At week 24, guselkumab Q4 and Q8 groups vs placebo showed higher least-squares mean changes in BASDAI (−2.7 and −2.7 vs −1.3; P less than .0001) and ASDAS (−1.4 and −1.4 vs −0.7; P less than .0001) scores, which were maintained until week 52.

Study details: This was a post hoc analysis of 2 DISCOVER studies including 312 patients with PsA with imaging-confirmed sacroiliitis who were randomly assigned to either placebo (n=118), guselkumab Q4 (n=103), or Q8 (n=91).

Disclosures: This study was funded by Janssen Research & Development LLC. The authors including the lead author reported grants and/or personal fees from various sources. Some of the authors declared being employees of Janssen Scientific Affairs LLC and Janssen Global Services LLC. Ten authors owned shares/stock options in Johnson & Johnson.

Source: Mease PJ et al. Lancet Rheumatol. 2021 Jun 29. doi: 10.1016/S2665-9913(21)00105-3.

Key clinical point: Patients with active psoriatic arthritis (PsA) and imaging-confirmed sacroiliitis treated with guselkumab every 4 weeks (Q4) or every 8 weeks (Q8) had greater mean improvements in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) score than placebo.

Major finding: At week 24, guselkumab Q4 and Q8 groups vs placebo showed higher least-squares mean changes in BASDAI (−2.7 and −2.7 vs −1.3; P less than .0001) and ASDAS (−1.4 and −1.4 vs −0.7; P less than .0001) scores, which were maintained until week 52.

Study details: This was a post hoc analysis of 2 DISCOVER studies including 312 patients with PsA with imaging-confirmed sacroiliitis who were randomly assigned to either placebo (n=118), guselkumab Q4 (n=103), or Q8 (n=91).

Disclosures: This study was funded by Janssen Research & Development LLC. The authors including the lead author reported grants and/or personal fees from various sources. Some of the authors declared being employees of Janssen Scientific Affairs LLC and Janssen Global Services LLC. Ten authors owned shares/stock options in Johnson & Johnson.

Source: Mease PJ et al. Lancet Rheumatol. 2021 Jun 29. doi: 10.1016/S2665-9913(21)00105-3.

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Clinical Edge Journal Scan Commentary: HCC August 2021

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Dr. Damjanov scans the journals, so you don’t have to!

Nevena Damjanov, MD

For patients with hepatocellular carcinoma (HCC) and liver-dominant disease, liver-directed therapy is frequently used as the initial attempt to control this malignancy. This month we will review several journal articles that address different forms of localized HCC management.

 

Ding W et al. analyzed 401 patients with early HCC who were treated in one center, either with microwave ablation (MWA, n=240) or robotic-assisted hepatectomy (RH, n=161). Following propensity-score matching (PSM) and inverse probability of treatment weight analysis, the authors found that both treatments can achieve safe, comparable therapeutic effects. The 3-year recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) of MWA group and RH group were 52.2% vs 65.8%, 91.5% vs 91.3% and 91.5% vs 91.3%, respectively. OS and CSS were comparable (P = 0.44 and 0.96), while RFS of patients treated with MWA was slightly lower but not significantly so (P = 0.097). The authors concluded that both minimally-invasive approaches are effective in the treatment of early HCC. MWA was less invasive, while RH had better accuracy and caused less damage to the liver parenchyma.

 

Transarterial therapies are frequently withheld in patients who have major vascular invasion (HCC-MVI), and patients usually receive palliative systemic therapy instead. Kwee et al. examined the National Cancer Database (NCDB) data to comparatively evaluate overall survival (OS) between transarterial radioembolization (TARE) and systemic therapy in hepatocellular carcinoma (HCC) with major vascular invasion (HCC-MVI). OS was compared by propensity-score matched Cox regression and landmark analysis in 1514 patients with HCC-MVI who were treated between 2010 and 2015. Propensity-score matched and landmark-time adjusted analysis associated TARE with a median OS 7.1 months (95% CI 5.0 to 10.5) vs 4.9 months (95% CI 3.9 to 6.5) for patients treated with systemic therapy only, HR 0.74 (95% CI 0.60 to 0.91, P = 0.005). The authors were encouraged by these results, and suggested that additional prospective studies using TARE as treatment of HCC-MVI should be undertaken.

 

 

The SARAH trial (Vilgrain et al., Lancet Oncology 2017) compared the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 (90Y) resin microspheres (also termed TARE, transarterial radioembolization) in patients with hepatocellular carcinoma. The final conclusion was that overall survival did not significantly differ between the two groups. Pereira et al. published this ancillary study of the SARAH trial that compares health-related quality of life (HRQoL) between the two groups. HRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7–4.3) in the TARE group, vs 2.6 months (95% CI 2.0–3.0) in the sorafenib group. The authors concluded that the differences in HRQoL should inform decisions when recommending initial treatment of patients with HCC, though it does not take into account recently developed advancements in systemic therapy including immunotherapy.

 

Author and Disclosure Information

Nevena Damjanov, MD, Professor, Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania; Chief, Department of Hematology-Oncology,  Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania

Nevena Damjanov, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: QED; Eisai

Received research grant from: Basilea; Bristol-Myers Squibb; Merck

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Nevena Damjanov, MD, Professor, Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania; Chief, Department of Hematology-Oncology,  Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania

Nevena Damjanov, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: QED; Eisai

Received research grant from: Basilea; Bristol-Myers Squibb; Merck

Author and Disclosure Information

Nevena Damjanov, MD, Professor, Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania; Chief, Department of Hematology-Oncology,  Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania

Nevena Damjanov, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: QED; Eisai

Received research grant from: Basilea; Bristol-Myers Squibb; Merck

Dr. Damjanov scans the journals, so you don’t have to!
Dr. Damjanov scans the journals, so you don’t have to!

Nevena Damjanov, MD

For patients with hepatocellular carcinoma (HCC) and liver-dominant disease, liver-directed therapy is frequently used as the initial attempt to control this malignancy. This month we will review several journal articles that address different forms of localized HCC management.

 

Ding W et al. analyzed 401 patients with early HCC who were treated in one center, either with microwave ablation (MWA, n=240) or robotic-assisted hepatectomy (RH, n=161). Following propensity-score matching (PSM) and inverse probability of treatment weight analysis, the authors found that both treatments can achieve safe, comparable therapeutic effects. The 3-year recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) of MWA group and RH group were 52.2% vs 65.8%, 91.5% vs 91.3% and 91.5% vs 91.3%, respectively. OS and CSS were comparable (P = 0.44 and 0.96), while RFS of patients treated with MWA was slightly lower but not significantly so (P = 0.097). The authors concluded that both minimally-invasive approaches are effective in the treatment of early HCC. MWA was less invasive, while RH had better accuracy and caused less damage to the liver parenchyma.

 

Transarterial therapies are frequently withheld in patients who have major vascular invasion (HCC-MVI), and patients usually receive palliative systemic therapy instead. Kwee et al. examined the National Cancer Database (NCDB) data to comparatively evaluate overall survival (OS) between transarterial radioembolization (TARE) and systemic therapy in hepatocellular carcinoma (HCC) with major vascular invasion (HCC-MVI). OS was compared by propensity-score matched Cox regression and landmark analysis in 1514 patients with HCC-MVI who were treated between 2010 and 2015. Propensity-score matched and landmark-time adjusted analysis associated TARE with a median OS 7.1 months (95% CI 5.0 to 10.5) vs 4.9 months (95% CI 3.9 to 6.5) for patients treated with systemic therapy only, HR 0.74 (95% CI 0.60 to 0.91, P = 0.005). The authors were encouraged by these results, and suggested that additional prospective studies using TARE as treatment of HCC-MVI should be undertaken.

 

 

The SARAH trial (Vilgrain et al., Lancet Oncology 2017) compared the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 (90Y) resin microspheres (also termed TARE, transarterial radioembolization) in patients with hepatocellular carcinoma. The final conclusion was that overall survival did not significantly differ between the two groups. Pereira et al. published this ancillary study of the SARAH trial that compares health-related quality of life (HRQoL) between the two groups. HRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7–4.3) in the TARE group, vs 2.6 months (95% CI 2.0–3.0) in the sorafenib group. The authors concluded that the differences in HRQoL should inform decisions when recommending initial treatment of patients with HCC, though it does not take into account recently developed advancements in systemic therapy including immunotherapy.

 

Nevena Damjanov, MD

For patients with hepatocellular carcinoma (HCC) and liver-dominant disease, liver-directed therapy is frequently used as the initial attempt to control this malignancy. This month we will review several journal articles that address different forms of localized HCC management.

 

Ding W et al. analyzed 401 patients with early HCC who were treated in one center, either with microwave ablation (MWA, n=240) or robotic-assisted hepatectomy (RH, n=161). Following propensity-score matching (PSM) and inverse probability of treatment weight analysis, the authors found that both treatments can achieve safe, comparable therapeutic effects. The 3-year recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) of MWA group and RH group were 52.2% vs 65.8%, 91.5% vs 91.3% and 91.5% vs 91.3%, respectively. OS and CSS were comparable (P = 0.44 and 0.96), while RFS of patients treated with MWA was slightly lower but not significantly so (P = 0.097). The authors concluded that both minimally-invasive approaches are effective in the treatment of early HCC. MWA was less invasive, while RH had better accuracy and caused less damage to the liver parenchyma.

 

Transarterial therapies are frequently withheld in patients who have major vascular invasion (HCC-MVI), and patients usually receive palliative systemic therapy instead. Kwee et al. examined the National Cancer Database (NCDB) data to comparatively evaluate overall survival (OS) between transarterial radioembolization (TARE) and systemic therapy in hepatocellular carcinoma (HCC) with major vascular invasion (HCC-MVI). OS was compared by propensity-score matched Cox regression and landmark analysis in 1514 patients with HCC-MVI who were treated between 2010 and 2015. Propensity-score matched and landmark-time adjusted analysis associated TARE with a median OS 7.1 months (95% CI 5.0 to 10.5) vs 4.9 months (95% CI 3.9 to 6.5) for patients treated with systemic therapy only, HR 0.74 (95% CI 0.60 to 0.91, P = 0.005). The authors were encouraged by these results, and suggested that additional prospective studies using TARE as treatment of HCC-MVI should be undertaken.

 

 

The SARAH trial (Vilgrain et al., Lancet Oncology 2017) compared the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 (90Y) resin microspheres (also termed TARE, transarterial radioembolization) in patients with hepatocellular carcinoma. The final conclusion was that overall survival did not significantly differ between the two groups. Pereira et al. published this ancillary study of the SARAH trial that compares health-related quality of life (HRQoL) between the two groups. HRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7–4.3) in the TARE group, vs 2.6 months (95% CI 2.0–3.0) in the sorafenib group. The authors concluded that the differences in HRQoL should inform decisions when recommending initial treatment of patients with HCC, though it does not take into account recently developed advancements in systemic therapy including immunotherapy.

 

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Liver resection yields limited success in HCC patients with hepatitis B/C coinfection

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Key clinical point: HCC patients with hepatitis B/C coinfection had worse long-term outcomes after liver resection than patients with hepatitis B infection only.

Major finding: In the propensity score matched cohort, 3-year and 5-year recurrence-free survival rates were significantly worse in HCC patients with hepatitis B/C coinfection (48.3% and 38.9%) than in those with hepatitis B only (61.8% and 49.2%, P = 0.037).

Study details: The data come from a multicenter, observational study of 2,467 adults with HCC who underwent curative-intent liver resection. Of these, 93 also had concurrent hepatitis B/C coinfection and 2,374 had hepatitis B. Propensity score matching paired patients with hepatitis B and hepatitis B/C co-infection.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Jia H-D et al. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.EP-44.

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Key clinical point: HCC patients with hepatitis B/C coinfection had worse long-term outcomes after liver resection than patients with hepatitis B infection only.

Major finding: In the propensity score matched cohort, 3-year and 5-year recurrence-free survival rates were significantly worse in HCC patients with hepatitis B/C coinfection (48.3% and 38.9%) than in those with hepatitis B only (61.8% and 49.2%, P = 0.037).

Study details: The data come from a multicenter, observational study of 2,467 adults with HCC who underwent curative-intent liver resection. Of these, 93 also had concurrent hepatitis B/C coinfection and 2,374 had hepatitis B. Propensity score matching paired patients with hepatitis B and hepatitis B/C co-infection.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Jia H-D et al. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.EP-44.

Key clinical point: HCC patients with hepatitis B/C coinfection had worse long-term outcomes after liver resection than patients with hepatitis B infection only.

Major finding: In the propensity score matched cohort, 3-year and 5-year recurrence-free survival rates were significantly worse in HCC patients with hepatitis B/C coinfection (48.3% and 38.9%) than in those with hepatitis B only (61.8% and 49.2%, P = 0.037).

Study details: The data come from a multicenter, observational study of 2,467 adults with HCC who underwent curative-intent liver resection. Of these, 93 also had concurrent hepatitis B/C coinfection and 2,374 had hepatitis B. Propensity score matching paired patients with hepatitis B and hepatitis B/C co-infection.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Jia H-D et al. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.EP-44.

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Laparoscopic repeat liver resection shows safety for recurrent HCC patients

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Key clinical point: Perioperative outcomes were significantly better in recurrent HCC patients who underwent laparoscopic repeat liver resection (LRLR) compared to those who had open laparoscopic repeat liver resection (ORLR).

Major finding: Patients with recurrent hepatocellular carcinoma who underwent LRLR had shorter operative times (mean 159.74 minutes vs 250.19 minutes), less intraoperative blood loss (mean 185.65 mL vs 385.56 mL), lower morbidity (8.6% vs 62.9%), and shorter hospital stays (mean 5.83 days vs 9.26 days) compared to patients who had ORLR.

Study details: The data come from a review of 50 cases of repeat liver resections performed at a single center between January 2009 and November 2020; 23 patients had laparoscopic procedures and 27 had open procedures.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Tagaytay TG et al. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.LV-PP-4-1.

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Key clinical point: Perioperative outcomes were significantly better in recurrent HCC patients who underwent laparoscopic repeat liver resection (LRLR) compared to those who had open laparoscopic repeat liver resection (ORLR).

Major finding: Patients with recurrent hepatocellular carcinoma who underwent LRLR had shorter operative times (mean 159.74 minutes vs 250.19 minutes), less intraoperative blood loss (mean 185.65 mL vs 385.56 mL), lower morbidity (8.6% vs 62.9%), and shorter hospital stays (mean 5.83 days vs 9.26 days) compared to patients who had ORLR.

Study details: The data come from a review of 50 cases of repeat liver resections performed at a single center between January 2009 and November 2020; 23 patients had laparoscopic procedures and 27 had open procedures.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Tagaytay TG et al. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.LV-PP-4-1.

Key clinical point: Perioperative outcomes were significantly better in recurrent HCC patients who underwent laparoscopic repeat liver resection (LRLR) compared to those who had open laparoscopic repeat liver resection (ORLR).

Major finding: Patients with recurrent hepatocellular carcinoma who underwent LRLR had shorter operative times (mean 159.74 minutes vs 250.19 minutes), less intraoperative blood loss (mean 185.65 mL vs 385.56 mL), lower morbidity (8.6% vs 62.9%), and shorter hospital stays (mean 5.83 days vs 9.26 days) compared to patients who had ORLR.

Study details: The data come from a review of 50 cases of repeat liver resections performed at a single center between January 2009 and November 2020; 23 patients had laparoscopic procedures and 27 had open procedures.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Tagaytay TG et al. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.LV-PP-4-1.

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Anatomical liver resection surpasses nonanatomical resection for overall survival in HCC

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Key clinical point: Overall survival at 3 and 5 years was significantly greater in HCC patients who underwent anatomical liver resection compared to those who had nonanatomical liver resection (hazard ratios 0.79 and 0.83, respectively).

Major finding: Patients who underwent anatomical liver resection showed significantly better recurrence-free survival at 1, 3, and 5 years compared to those who underwent nonanatomical liver resection (HR 0.79, 0.81, and 0.82, respectively); anatomical liver resection patients also showed improved recurrence-free survival in a subgroup analysis of tumors less than 5 cm in diameter.

Study details: The data come from a meta-analysis of 19 propensity score matching studies of hepatocellular carcinoma patients who underwent anatomical or nonanatomical liver resection.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Shin S and Kim T-S. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.EP-37.

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Key clinical point: Overall survival at 3 and 5 years was significantly greater in HCC patients who underwent anatomical liver resection compared to those who had nonanatomical liver resection (hazard ratios 0.79 and 0.83, respectively).

Major finding: Patients who underwent anatomical liver resection showed significantly better recurrence-free survival at 1, 3, and 5 years compared to those who underwent nonanatomical liver resection (HR 0.79, 0.81, and 0.82, respectively); anatomical liver resection patients also showed improved recurrence-free survival in a subgroup analysis of tumors less than 5 cm in diameter.

Study details: The data come from a meta-analysis of 19 propensity score matching studies of hepatocellular carcinoma patients who underwent anatomical or nonanatomical liver resection.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Shin S and Kim T-S. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.EP-37.

Key clinical point: Overall survival at 3 and 5 years was significantly greater in HCC patients who underwent anatomical liver resection compared to those who had nonanatomical liver resection (hazard ratios 0.79 and 0.83, respectively).

Major finding: Patients who underwent anatomical liver resection showed significantly better recurrence-free survival at 1, 3, and 5 years compared to those who underwent nonanatomical liver resection (HR 0.79, 0.81, and 0.82, respectively); anatomical liver resection patients also showed improved recurrence-free survival in a subgroup analysis of tumors less than 5 cm in diameter.

Study details: The data come from a meta-analysis of 19 propensity score matching studies of hepatocellular carcinoma patients who underwent anatomical or nonanatomical liver resection.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Shin S and Kim T-S. Ann Hepatobiliary Pancreat Surg. 2021 Jun 30. doi: 10.14701/ahbps.EP-37.

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Lenvatinib extends time to disease progression in HCC patients with portal vein tumor thrombus

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Key clinical point: Hepatocellular carcinoma patients with PVTT who received lenvatinib had a significantly longer time to progression compared to those treated with sorafenib.

Major finding: The median time to progression was 4.7 months for HCC patients with PVTT who received lenvatinib, compared to 3.1 months for those treated with sorafenib (hazard ratio 0.55, P = .029). In addition, objective response rates were significantly higher in the lenvatinib group vs the sorafenib group (53.1% vs 25.0%).

 

Study details: The data come from an open-label, single-center, randomized trial of 64 adults with previous untreated hepatocellular carcinoma and portal vein tumor thrombus (PVTT). Patients received TACE plus lenvatinib or sorafenib.

Disclosures: The study was supported by the Beijing Municipal Hospital Management Center Young Talent Training program. The researchers had no financial conflicts to disclose.

Source: Ding X et al. Cancer. 2021 Jul 8. doi: 10.1002/cncr.33677. 

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Key clinical point: Hepatocellular carcinoma patients with PVTT who received lenvatinib had a significantly longer time to progression compared to those treated with sorafenib.

Major finding: The median time to progression was 4.7 months for HCC patients with PVTT who received lenvatinib, compared to 3.1 months for those treated with sorafenib (hazard ratio 0.55, P = .029). In addition, objective response rates were significantly higher in the lenvatinib group vs the sorafenib group (53.1% vs 25.0%).

 

Study details: The data come from an open-label, single-center, randomized trial of 64 adults with previous untreated hepatocellular carcinoma and portal vein tumor thrombus (PVTT). Patients received TACE plus lenvatinib or sorafenib.

Disclosures: The study was supported by the Beijing Municipal Hospital Management Center Young Talent Training program. The researchers had no financial conflicts to disclose.

Source: Ding X et al. Cancer. 2021 Jul 8. doi: 10.1002/cncr.33677. 

Key clinical point: Hepatocellular carcinoma patients with PVTT who received lenvatinib had a significantly longer time to progression compared to those treated with sorafenib.

Major finding: The median time to progression was 4.7 months for HCC patients with PVTT who received lenvatinib, compared to 3.1 months for those treated with sorafenib (hazard ratio 0.55, P = .029). In addition, objective response rates were significantly higher in the lenvatinib group vs the sorafenib group (53.1% vs 25.0%).

 

Study details: The data come from an open-label, single-center, randomized trial of 64 adults with previous untreated hepatocellular carcinoma and portal vein tumor thrombus (PVTT). Patients received TACE plus lenvatinib or sorafenib.

Disclosures: The study was supported by the Beijing Municipal Hospital Management Center Young Talent Training program. The researchers had no financial conflicts to disclose.

Source: Ding X et al. Cancer. 2021 Jul 8. doi: 10.1002/cncr.33677. 

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