Clinical Outcomes and Prognosis Factors of Nivolumab Plus Chemotherapy or Multitarget Tyrosine Kinase Inhibitor in Multi-Line Therapy for Recurrent Hepatitis B Virus-Related Hepatocellular Carcinoma: A Retrospective Analysis

Chao Chen,Zixiong Li,Ying Cheng,Li An,Xiufeng Liu,Xianwen Luo

doi:10.3389/fonc.2020.01404

Abstract

Background: This study investigates the potential predictors of nivolumab plus chemotherapy or multitarget tyrosine kinase inhibitor (TKI) treatment response in patients with recurrent hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).Methods: Patients with recurrent hepatitis B virus-related HCC who underwent nivolumab plus chemotherapy or TKI treatment between July 2017 and June 2019 at Jinling Hospital in China were retrospectively evaluated and included in this study. These patients also had both complete medical charts and follow-up data available. Overall survival (OS) and progression-free survival (PFS) were calculated from the date of nivolumab initiation. Survival data were compared using log-rank tests, and the associations of patient characteristics with survival were estimated using Cox regression models.Results: A total of 22 HCC patients were included in this cohort and constituted the basis for this analysis. Twenty progressed cases (91%) and 16 deaths (73%) were identified at a median follow-up of 8.8 months (range 1–25). The median OS from the time of nivolumab initiation was 10.7 months (95% CI, 0.8–20.6 months), with a median PFS of 5.1 months (95% CI, 3.1–7.0 months). The patients were divided into two risk groups according to a nomogram built by age, Eastern Cooperative Oncology Group (ECOG) status, hepatectomy status, and transarterial chemoembolization (TACE) use. The median PFS was 8.2 ± 2.8 months in the low-risk group compared with 1.9 ± 0.4 months in the high-risk group (p = 0.0018). The median OS was estimated as 16.8 ± 4.9 months for low-risk patients vs. 8.6 ± 3.5 months for high-risk patients (p = 0.13).Conclusion: Nivolumab combined with chemotherapy or TKI treatment is effective in patients with recurrent hepatitis B virus-related HCC. It is observed that previous TACE treatment is associated with a better PFS, and worse PFS in those patients who received hepatectomy. Prospective studies are warranted to evaluate the effects of nivolumab combined chemotherapy or TKI on recurrent hepatitis B virus-related HCC.

Highlights

Hepatocellular carcinoma (HCC) is currently ranked as the third leading cause of cancer-related mortality worldwide [1]
A total of 22 patients with recurrent hepatitis B virus-related HCC who started nivolumab treatment between July 2017 and June 2019 at Jinling Hospital in China were included in this study
Patients received 3 mg/kg intravenous nivolumab every 3 weeks until disease progression, combined with tyrosine kinase inhibitor (TKI) in 15 patients and chemotherapy in seven patients

Summary

Introduction

Hepatocellular carcinoma (HCC) is currently ranked as the third leading cause of cancer-related mortality worldwide [1]. The HCC mortality rate has been increasing, in males aged 45 to 74 years old with chronic hepatitis B and hepatitis C viral infection, over recent decades [2]. Hepatic resection remains the mainstay for curative treatment of HCC [3]. Long-term outcomes after resection remain unsatisfactory, with a high rate of recurrence of up to 60 to 70% within 5 years [1, 4, 5]. This study investigates the potential predictors of nivolumab plus chemotherapy or multitarget tyrosine kinase inhibitor (TKI) treatment response in patients with recurrent hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC)

Methods

Results

Conclusion