Hepatocellular Carcinoma

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: The excellent 10-year post-liver transplant (LT) outcomes in patients with hepatocellular carcinoma (HCC) successfully downstaged to within Milan criteria (MC) substantiate the validity of the national downstaging policy.

Major finding: At 10 years after LT, patients with HCC always within MC, those with HCC downstaged before LT, and those with HCC unsuccessfully downstaged/progressed beyond MC during LT had survival rates of 61.5%, 52.1%, and 43.3%, respectively, and recurrence rates of 13.3%, 20.6%, and 41.4%, respectively.

Study details: This retrospective cohort study analyzed the prospective data of 2645 adult patients with HCC who underwent LT at 5 US academic centers.

Disclosures: This study was sponsored by the US Department of Defense, Samuel Waxman Cancer Research Foundation, Spanish National Health Institute, and Cancer Research UK, among others. Two authors reported receiving grants or a board of directors’ honoraria from various sources.

Source: Tabrizian P et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022 (Jul 20). Doi: 10.1001/jamasurg.2022.2800

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Patients with hepatitis B virus (HBV) infection and HCC tend to live longer if both their HBV and HCC are treated. Liu and colleagues performed a meta-analysis of trials that addressed the question whether the same is true for patients with hepatitis C virus (HCV) infection and HCC treated with either interferon or direct-acting antivirals (DAA). They included 23, mostly retrospective, cohort studies in the final meta-analysis. Recurrence data were available in 18 studies, with 2013 patients receiving DAA therapy, 1091 patients receiving interferon therapy, and 1571 patients receiving no intervention. There was no significant difference in recurrence between the DAA group and the interferon group. The meta-analysis demonstrated that patients with HCV-related HCC treated with DAA had a lower risk for HCC recurrence (adjusted hazard ratio [HR] 0.55, 95% CI 0.41-0.74, P < .001; I² 66.6%, P < .001) and a better overall survival (OS) (adjusted HR 0.36, 95% CI 0.16–0.83, P = .017; I² 90.7%, P < .001) than patients with no intervention. The authors concluded that DAA therapy can prevent recurrence and improve OS of patients with HCV-related HCC, especially if a sustained virologic response is achieved.

Atezolizumab with bevacizumab is the current first-line standard of care for patients with unresectable HCC, offering an improved OS compared to sorafenib, as demonstrated in the phase 3 IMbrave150 study. Alternate combinations, such as atezolizumab and cabozantinib, are also being investigated in this setting. The COSMIC-312 phase 3 randomized controlled trial evaluated 837 patients with unresectable HCC who had not received previous systemic therapy. They were randomly assigned in a 2:1:1 ratio to receive cabozantinib plus atezolizumab (n = 432), sorafenib (n = 217), or single-agent cabozantinib (n = 188). Although the patients receiving atezolizumab + cabozantinib had a significantly longer median progression-free survival (6.8 vs 4.2 months; HR, 0.63; P = .001) than patients who received sorafenib, both groups had a similar median OS (15.4 vs 15.5 months; HR, 0.90; P = .44). The authors concluded that this combination requires more study in this patient population.

For patients with unresectable HCC who are unable to tolerate combination therapy in the first-line setting, single-agent therapy might be an option. Verset and colleagues reported the results of a phase 2 study evaluating pembrolizumab in this setting. Cohort 2 of the KEYNOTE-224 study evaluated 51 systemic therapy–naive patients with unresectable HCC who received pembrolizumab for up to 2 years. After 27 months of median follow-up, the median progression-free survival was 4 months (95% CI 2-8 months) and the OS was 17 months (95% CI 8-23 months). The objective response rate was 16% (95% CI 7%-29%). Grade ≥ 3 treatment-related adverse events were observed in 16% of patients. In this prospective study, pembrolizumab provided durable antitumor activity, a promising OS, and a safety profile consistent with previous observations.

Patients with hepatitis B virus (HBV) infection and HCC tend to live longer if both their HBV and HCC are treated. Liu and colleagues performed a meta-analysis of trials that addressed the question whether the same is true for patients with hepatitis C virus (HCV) infection and HCC treated with either interferon or direct-acting antivirals (DAA). They included 23, mostly retrospective, cohort studies in the final meta-analysis. Recurrence data were available in 18 studies, with 2013 patients receiving DAA therapy, 1091 patients receiving interferon therapy, and 1571 patients receiving no intervention. There was no significant difference in recurrence between the DAA group and the interferon group. The meta-analysis demonstrated that patients with HCV-related HCC treated with DAA had a lower risk for HCC recurrence (adjusted hazard ratio [HR] 0.55, 95% CI 0.41-0.74, P < .001; I² 66.6%, P < .001) and a better overall survival (OS) (adjusted HR 0.36, 95% CI 0.16–0.83, P = .017; I² 90.7%, P < .001) than patients with no intervention. The authors concluded that DAA therapy can prevent recurrence and improve OS of patients with HCV-related HCC, especially if a sustained virologic response is achieved.

Atezolizumab with bevacizumab is the current first-line standard of care for patients with unresectable HCC, offering an improved OS compared to sorafenib, as demonstrated in the phase 3 IMbrave150 study. Alternate combinations, such as atezolizumab and cabozantinib, are also being investigated in this setting. The COSMIC-312 phase 3 randomized controlled trial evaluated 837 patients with unresectable HCC who had not received previous systemic therapy. They were randomly assigned in a 2:1:1 ratio to receive cabozantinib plus atezolizumab (n = 432), sorafenib (n = 217), or single-agent cabozantinib (n = 188). Although the patients receiving atezolizumab + cabozantinib had a significantly longer median progression-free survival (6.8 vs 4.2 months; HR, 0.63; P = .001) than patients who received sorafenib, both groups had a similar median OS (15.4 vs 15.5 months; HR, 0.90; P = .44). The authors concluded that this combination requires more study in this patient population.

For patients with unresectable HCC who are unable to tolerate combination therapy in the first-line setting, single-agent therapy might be an option. Verset and colleagues reported the results of a phase 2 study evaluating pembrolizumab in this setting. Cohort 2 of the KEYNOTE-224 study evaluated 51 systemic therapy–naive patients with unresectable HCC who received pembrolizumab for up to 2 years. After 27 months of median follow-up, the median progression-free survival was 4 months (95% CI 2-8 months) and the OS was 17 months (95% CI 8-23 months). The objective response rate was 16% (95% CI 7%-29%). Grade ≥ 3 treatment-related adverse events were observed in 16% of patients. In this prospective study, pembrolizumab provided durable antitumor activity, a promising OS, and a safety profile consistent with previous observations.

Patients with hepatitis B virus (HBV) infection and HCC tend to live longer if both their HBV and HCC are treated. Liu and colleagues performed a meta-analysis of trials that addressed the question whether the same is true for patients with hepatitis C virus (HCV) infection and HCC treated with either interferon or direct-acting antivirals (DAA). They included 23, mostly retrospective, cohort studies in the final meta-analysis. Recurrence data were available in 18 studies, with 2013 patients receiving DAA therapy, 1091 patients receiving interferon therapy, and 1571 patients receiving no intervention. There was no significant difference in recurrence between the DAA group and the interferon group. The meta-analysis demonstrated that patients with HCV-related HCC treated with DAA had a lower risk for HCC recurrence (adjusted hazard ratio [HR] 0.55, 95% CI 0.41-0.74, P < .001; I² 66.6%, P < .001) and a better overall survival (OS) (adjusted HR 0.36, 95% CI 0.16–0.83, P = .017; I² 90.7%, P < .001) than patients with no intervention. The authors concluded that DAA therapy can prevent recurrence and improve OS of patients with HCV-related HCC, especially if a sustained virologic response is achieved.

Atezolizumab with bevacizumab is the current first-line standard of care for patients with unresectable HCC, offering an improved OS compared to sorafenib, as demonstrated in the phase 3 IMbrave150 study. Alternate combinations, such as atezolizumab and cabozantinib, are also being investigated in this setting. The COSMIC-312 phase 3 randomized controlled trial evaluated 837 patients with unresectable HCC who had not received previous systemic therapy. They were randomly assigned in a 2:1:1 ratio to receive cabozantinib plus atezolizumab (n = 432), sorafenib (n = 217), or single-agent cabozantinib (n = 188). Although the patients receiving atezolizumab + cabozantinib had a significantly longer median progression-free survival (6.8 vs 4.2 months; HR, 0.63; P = .001) than patients who received sorafenib, both groups had a similar median OS (15.4 vs 15.5 months; HR, 0.90; P = .44). The authors concluded that this combination requires more study in this patient population.

For patients with unresectable HCC who are unable to tolerate combination therapy in the first-line setting, single-agent therapy might be an option. Verset and colleagues reported the results of a phase 2 study evaluating pembrolizumab in this setting. Cohort 2 of the KEYNOTE-224 study evaluated 51 systemic therapy–naive patients with unresectable HCC who received pembrolizumab for up to 2 years. After 27 months of median follow-up, the median progression-free survival was 4 months (95% CI 2-8 months) and the OS was 17 months (95% CI 8-23 months). The objective response rate was 16% (95% CI 7%-29%). Grade ≥ 3 treatment-related adverse events were observed in 16% of patients. In this prospective study, pembrolizumab provided durable antitumor activity, a promising OS, and a safety profile consistent with previous observations.

Patients with hepatitis B virus (HBV) infection and HCC tend to live longer if both their HBV and HCC are treated. Liu and colleagues performed a meta-analysis of trials that addressed the question whether the same is true for patients with hepatitis C virus (HCV) infection and HCC treated with either interferon or direct-acting antivirals (DAA). They included 23, mostly retrospective, cohort studies in the final meta-analysis. Recurrence data were available in 18 studies, with 2013 patients receiving DAA therapy, 1091 patients receiving interferon therapy, and 1571 patients receiving no intervention. There was no significant difference in recurrence between the DAA group and the interferon group. The meta-analysis demonstrated that patients with HCV-related HCC treated with DAA had a lower risk for HCC recurrence (adjusted hazard ratio [HR] 0.55, 95% CI 0.41-0.74, P < .001; I² 66.6%, P < .001) and a better overall survival (OS) (adjusted HR 0.36, 95% CI 0.16–0.83, P = .017; I² 90.7%, P < .001) than patients with no intervention. The authors concluded that DAA therapy can prevent recurrence and improve OS of patients with HCV-related HCC, especially if a sustained virologic response is achieved.

Atezolizumab with bevacizumab is the current first-line standard of care for patients with unresectable HCC, offering an improved OS compared to sorafenib, as demonstrated in the phase 3 IMbrave150 study. Alternate combinations, such as atezolizumab and cabozantinib, are also being investigated in this setting. The COSMIC-312 phase 3 randomized controlled trial evaluated 837 patients with unresectable HCC who had not received previous systemic therapy. They were randomly assigned in a 2:1:1 ratio to receive cabozantinib plus atezolizumab (n = 432), sorafenib (n = 217), or single-agent cabozantinib (n = 188). Although the patients receiving atezolizumab + cabozantinib had a significantly longer median progression-free survival (6.8 vs 4.2 months; HR, 0.63; P = .001) than patients who received sorafenib, both groups had a similar median OS (15.4 vs 15.5 months; HR, 0.90; P = .44). The authors concluded that this combination requires more study in this patient population.

For patients with unresectable HCC who are unable to tolerate combination therapy in the first-line setting, single-agent therapy might be an option. Verset and colleagues reported the results of a phase 2 study evaluating pembrolizumab in this setting. Cohort 2 of the KEYNOTE-224 study evaluated 51 systemic therapy–naive patients with unresectable HCC who received pembrolizumab for up to 2 years. After 27 months of median follow-up, the median progression-free survival was 4 months (95% CI 2-8 months) and the OS was 17 months (95% CI 8-23 months). The objective response rate was 16% (95% CI 7%-29%). Grade ≥ 3 treatment-related adverse events were observed in 16% of patients. In this prospective study, pembrolizumab provided durable antitumor activity, a promising OS, and a safety profile consistent with previous observations.

Patients with hepatitis B virus (HBV) infection and HCC tend to live longer if both their HBV and HCC are treated. Liu and colleagues performed a meta-analysis of trials that addressed the question whether the same is true for patients with hepatitis C virus (HCV) infection and HCC treated with either interferon or direct-acting antivirals (DAA). They included 23, mostly retrospective, cohort studies in the final meta-analysis. Recurrence data were available in 18 studies, with 2013 patients receiving DAA therapy, 1091 patients receiving interferon therapy, and 1571 patients receiving no intervention. There was no significant difference in recurrence between the DAA group and the interferon group. The meta-analysis demonstrated that patients with HCV-related HCC treated with DAA had a lower risk for HCC recurrence (adjusted hazard ratio [HR] 0.55, 95% CI 0.41-0.74, P < .001; I² 66.6%, P < .001) and a better overall survival (OS) (adjusted HR 0.36, 95% CI 0.16–0.83, P = .017; I² 90.7%, P < .001) than patients with no intervention. The authors concluded that DAA therapy can prevent recurrence and improve OS of patients with HCV-related HCC, especially if a sustained virologic response is achieved.

Atezolizumab with bevacizumab is the current first-line standard of care for patients with unresectable HCC, offering an improved OS compared to sorafenib, as demonstrated in the phase 3 IMbrave150 study. Alternate combinations, such as atezolizumab and cabozantinib, are also being investigated in this setting. The COSMIC-312 phase 3 randomized controlled trial evaluated 837 patients with unresectable HCC who had not received previous systemic therapy. They were randomly assigned in a 2:1:1 ratio to receive cabozantinib plus atezolizumab (n = 432), sorafenib (n = 217), or single-agent cabozantinib (n = 188). Although the patients receiving atezolizumab + cabozantinib had a significantly longer median progression-free survival (6.8 vs 4.2 months; HR, 0.63; P = .001) than patients who received sorafenib, both groups had a similar median OS (15.4 vs 15.5 months; HR, 0.90; P = .44). The authors concluded that this combination requires more study in this patient population.

For patients with unresectable HCC who are unable to tolerate combination therapy in the first-line setting, single-agent therapy might be an option. Verset and colleagues reported the results of a phase 2 study evaluating pembrolizumab in this setting. Cohort 2 of the KEYNOTE-224 study evaluated 51 systemic therapy–naive patients with unresectable HCC who received pembrolizumab for up to 2 years. After 27 months of median follow-up, the median progression-free survival was 4 months (95% CI 2-8 months) and the OS was 17 months (95% CI 8-23 months). The objective response rate was 16% (95% CI 7%-29%). Grade ≥ 3 treatment-related adverse events were observed in 16% of patients. In this prospective study, pembrolizumab provided durable antitumor activity, a promising OS, and a safety profile consistent with previous observations.

Patients with hepatitis B virus (HBV) infection and HCC tend to live longer if both their HBV and HCC are treated. Liu and colleagues performed a meta-analysis of trials that addressed the question whether the same is true for patients with hepatitis C virus (HCV) infection and HCC treated with either interferon or direct-acting antivirals (DAA). They included 23, mostly retrospective, cohort studies in the final meta-analysis. Recurrence data were available in 18 studies, with 2013 patients receiving DAA therapy, 1091 patients receiving interferon therapy, and 1571 patients receiving no intervention. There was no significant difference in recurrence between the DAA group and the interferon group. The meta-analysis demonstrated that patients with HCV-related HCC treated with DAA had a lower risk for HCC recurrence (adjusted hazard ratio [HR] 0.55, 95% CI 0.41-0.74, P < .001; I² 66.6%, P < .001) and a better overall survival (OS) (adjusted HR 0.36, 95% CI 0.16–0.83, P = .017; I² 90.7%, P < .001) than patients with no intervention. The authors concluded that DAA therapy can prevent recurrence and improve OS of patients with HCV-related HCC, especially if a sustained virologic response is achieved.

Atezolizumab with bevacizumab is the current first-line standard of care for patients with unresectable HCC, offering an improved OS compared to sorafenib, as demonstrated in the phase 3 IMbrave150 study. Alternate combinations, such as atezolizumab and cabozantinib, are also being investigated in this setting. The COSMIC-312 phase 3 randomized controlled trial evaluated 837 patients with unresectable HCC who had not received previous systemic therapy. They were randomly assigned in a 2:1:1 ratio to receive cabozantinib plus atezolizumab (n = 432), sorafenib (n = 217), or single-agent cabozantinib (n = 188). Although the patients receiving atezolizumab + cabozantinib had a significantly longer median progression-free survival (6.8 vs 4.2 months; HR, 0.63; P = .001) than patients who received sorafenib, both groups had a similar median OS (15.4 vs 15.5 months; HR, 0.90; P = .44). The authors concluded that this combination requires more study in this patient population.

For patients with unresectable HCC who are unable to tolerate combination therapy in the first-line setting, single-agent therapy might be an option. Verset and colleagues reported the results of a phase 2 study evaluating pembrolizumab in this setting. Cohort 2 of the KEYNOTE-224 study evaluated 51 systemic therapy–naive patients with unresectable HCC who received pembrolizumab for up to 2 years. After 27 months of median follow-up, the median progression-free survival was 4 months (95% CI 2-8 months) and the OS was 17 months (95% CI 8-23 months). The objective response rate was 16% (95% CI 7%-29%). Grade ≥ 3 treatment-related adverse events were observed in 16% of patients. In this prospective study, pembrolizumab provided durable antitumor activity, a promising OS, and a safety profile consistent with previous observations.

Key clinical point: Use of beta-adrenergic receptor blockers is associated with prolonged survival in patients with hepatocellular carcinoma (HCC).

Major finding: Beta-blocker use was associated with better overall survival (hazard ratio 0.69; P  =  .0031), with no significant heterogeneity across studies (I²  =  41%; P  =  .18).

Study details: The data come from a meta-analysis of 3 cohort studies involving 5148 patients with HCC that analyzed the association between the use of beta-blockers (including propranolol) and overall survival of the patients.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Chang H and Lee SH. Beta-adrenergic receptor blockers and hepatocellular carcinoma survival: A systemic review and meta-analysis. Clin Exp Med. 2022 (Jun 23). Doi: 10.1007/s10238-022-00842-z

Key clinical point: Use of beta-adrenergic receptor blockers is associated with prolonged survival in patients with hepatocellular carcinoma (HCC).

Major finding: Beta-blocker use was associated with better overall survival (hazard ratio 0.69; P  =  .0031), with no significant heterogeneity across studies (I²  =  41%; P  =  .18).

Study details: The data come from a meta-analysis of 3 cohort studies involving 5148 patients with HCC that analyzed the association between the use of beta-blockers (including propranolol) and overall survival of the patients.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Chang H and Lee SH. Beta-adrenergic receptor blockers and hepatocellular carcinoma survival: A systemic review and meta-analysis. Clin Exp Med. 2022 (Jun 23). Doi: 10.1007/s10238-022-00842-z

Key clinical point: Use of beta-adrenergic receptor blockers is associated with prolonged survival in patients with hepatocellular carcinoma (HCC).

Major finding: Beta-blocker use was associated with better overall survival (hazard ratio 0.69; P  =  .0031), with no significant heterogeneity across studies (I²  =  41%; P  =  .18).

Study details: The data come from a meta-analysis of 3 cohort studies involving 5148 patients with HCC that analyzed the association between the use of beta-blockers (including propranolol) and overall survival of the patients.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Chang H and Lee SH. Beta-adrenergic receptor blockers and hepatocellular carcinoma survival: A systemic review and meta-analysis. Clin Exp Med. 2022 (Jun 23). Doi: 10.1007/s10238-022-00842-z