Abstract
BackgroundPrevious studies have explored cancer immunotherapy with radiotherapy or anti-angiogenic therapy, but no trials have reported a triple therapy approach. This study aimed to investigate safety and clinical outcome of PD-1/PD-L1 inhibitors combined with palliative radiotherapy and targeted angiogenesis therapy in hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage C.MethodsConsecutive patients (n=16) treated with PD-1/PD-L1 inhibitors combined with radiotherapy and anti-angiogenic therapy in a bi-institutional cohort between July 2017 and December 2020 were retrospectively included. Radiotherapy was conducted within 14 days of the first administration of immunotherapy. The primary endpoint was treatment-related adverse event (TRAE).ResultsThe median follow-up was 383 days. Fifteen patients (93.8%) experienced at least 1 TRAE. The most common TRAEs of any grade were rash (25%), diarrhea (25%), aspartate aminotransferase increase (18.8%), alanine transaminase increase (18.8%), decreased appetite (18.8%), and fatigue (18.8%). Grade 3/4 TRAEs occurred in 4 patients (25%) and finally led to treatment interruption. No patient death was attributed to treatment. No specific events were responsible for the addition of radiotherapy. Six patients showed partial response, 7 showed stable disease, and 2 showed progressive disease. The objective response rate and disease control rate were 40.0% (95% CI 16.3%–67.7%) and 86.7% (95% CI 59.5%–98.3%), respectively. Moreover, the median progression-free survival was 140 days. Patients had a median overall survival of 637 days, and the estimated rates of survival at 6 and 12 months were 92.3% and 75.5%, respectively.ConclusionPD-1/PD-L1 inhibitors combined with palliative radiotherapy and anti-angiogenic therapy appear to be safe, with no unexpected adverse events. Additional studies exploring the clinical benefit are warranted.
Highlights
Hepatocellular carcinoma (HCC) is a type of cancer that is common worldwide and the fourth most common cause of cancer-related deaths worldwide [1]
This study aimed to investigate safety and clinical outcome of progressive disease (PD)-1/PD-L1 inhibitors combined with palliative radiotherapy and targeted angiogenesis therapy in hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage C
No patient death was attributed to treatment
Summary
Hepatocellular carcinoma (HCC) is a type of cancer that is common worldwide and the fourth most common cause of cancer-related deaths worldwide [1]. Most HCC patients are diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage C, are unresponsive to curative therapies, and exhibit a very poor prognosis. Combination therapies involving PD-1/PD-L1 inhibitors are being studied for a variety of malignancies, such as non–small cell lung cancer (NSCLC), renal cell carcinoma, and endometrial cancer [6, 7]. For unresectable HCC, a combination of atezolizumab plus bevacizumab succeeded in a front-line Phase 3 trial (IMbrave150). Atezolizumab plus bevacizumab became the new standard of first-line therapy. This study aimed to investigate safety and clinical outcome of PD-1/PD-L1 inhibitors combined with palliative radiotherapy and targeted angiogenesis therapy in hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage C
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