Abstract
More than half of new cases of hepatocellular carcinoma (HCC) and associated deaths occurring annually worldwide are recorded in China. Chinese patients with HCC exhibit special characteristics in terms of etiology, leading to differences in prognosis versus Western patients. In recent years, several angiogenesis inhibitors were approved, and immune checkpoint blockers (ICBs) were recommended as second-line therapy for advanced HCC. In addition, the recent success of a combination of atezolizumab with bevacizumab signals resulted in an essential change in the first-line treatment of HCC. We investigated the characteristics of patients with HCC in China and summarized the rapidly emerging relevant clinical data, which relate to the prospects and challenges associated with the use of ICBs in this setting. We further evaluated the efficacy of ICBs in Chinese patients with HCC based on data obtained from global trials, and discussed possible factors influencing the effectiveness of ICBs in patients with HCC in China. Immunotherapy offers new options for the treatment of advanced HCC, though responses varied between patients. Currently, there is a need to discover specific biomarkers for the accurate identification of patients who would more likely benefit from immunotherapy. Furthermore, investigation of patient characteristics in different countries is necessary to provide a clinical practice basis and reference value for the diagnosis and treatment of HCC.
Highlights
According to 2018 Global Cancer Statistics, liver cancer is the sixth most common and fourth most deadly type of cancer worldwide, and hepatocellular carcinoma (HCC) accounts for 75%–85% of cases [1]
A retrospective study evaluated the efficacy of hepatic artery infusion chemotherapy (HAIC) or HAIC combined with anti-programmed cell death 1 (PD-1) immunotherapy (HAICAP) in patients with advanced Hepatocellular Carcinoma (HCC)
The results revealed that LeTOHAIC was associated with longer progression-free survival (PFS) (11.1 vs. 5.1 months, respectively; Hazard ratio (HR) = 0.48, 95% CI: 0.33–0.7, P < 0.001) and Overall survival (OS) (< 11 months; HR = 0.4, 95% CI: 0.24–0.66, P < 0.001)
Summary
According to 2018 Global Cancer Statistics, liver cancer is the sixth most common and fourth most deadly type of cancer worldwide, and hepatocellular carcinoma (HCC) accounts for 75%–85% of cases [1]. HCC is very common in China, accounting for 55.41% and 53.96% of the total number of new liver cancer cases and related deaths, respectively, reported worldwide in 2018 [2]. The 5-year survival rate of patients with HCC in China remains very low (i.e., < 13%) [3]. The reasons for this poor survival rate are as follows. Differences in background characteristics and etiology between Chinese and Western patients [8] result in a low objective response rate to treatment and limited survival benefits [9, 10]. Clinical studies on immunotherapy for patients with HCC in China are ongoing, showing significant benefits. We analyzed differences in the efficacy of immunotherapy between Chinese and Western patients according to global results. More clinical trials tailored to national and ethnic characteristics are warranted to investigate differences in clinical results due to particular patient characteristics in different geographical regions
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