TY - JOUR
T1 - Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma
AU - Yeo, Yee Hui
AU - Liang, Jeff
AU - Lauzon, Marie
AU - Luu, Michael
AU - Noureddin, Mazen
AU - Ayoub, Walid
AU - Kuo, Alexander
AU - Sankar, Kamya
AU - Gong, Jun
AU - Hendifar, Andrew
AU - Osipov, Arsen
AU - Friedman, Marc L.
AU - Gabriel Lipshutz, H.
AU - Steinberger, Jonathan
AU - Kosari, Kambiz
AU - Nissen, Nicholas
AU - Abou-Alfa, Ghassan K.
AU - Singal, Amit G.
AU - Yang, Ju Dong
N1 - Publisher Copyright:
© 2023 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - INTRODUCTION:The efficacy and safety of combined immunotherapy and transarterial radioembolization (TARE) were suggested in preclinical and early-phase trials, but these were limited by small sample sizes. We sought to compare the efficacy of combined therapy and immunotherapy alone in patients with advanced hepatocellular carcinoma (HCC).METHODS:The National Cancer Database was used to identify patients with advanced HCC diagnosed between January 1, 2017, and December 31, 2019. We included patients who received combined therapy or immunotherapy alone as first-line treatment. Multivariable logistic regression was conducted to determine predictors of combined therapy. Kaplan-Meier and Cox regression approaches were used to identify predictors of overall survival and to compare hazards of mortality between the patients who received combined therapy and immunotherapy alone.RESULTS:Of 1,664 eligible patients with advanced-stage HCC, 142 received combined TARE/immunotherapy and 1,522 received immunotherapy alone. Receipt of combination therapy was associated with care at an academic center and inversely associated with racial/ethnic minority status (Hispanic and Black individuals). The median overall survival was significantly higher in the combination group than in the immunotherapy alone group (19.8 vs 9.5 months). In multivariable analysis, combined therapy was independently associated with reduced mortality (adjusted hazard ratio 0.50, 95% confidence interval: 0.36-0.68, P < 0.001). Results were consistent across subgroups and in sensitivity analyses using propensity score matching and inverse probability of treatment weighting.DISCUSSION:The combination of TARE and immunotherapy was associated with improved survival compared with immunotherapy alone in patients with advanced-stage HCC. Our findings underly the importance of large clinical trials evaluating combination therapy in these patients.
AB - INTRODUCTION:The efficacy and safety of combined immunotherapy and transarterial radioembolization (TARE) were suggested in preclinical and early-phase trials, but these were limited by small sample sizes. We sought to compare the efficacy of combined therapy and immunotherapy alone in patients with advanced hepatocellular carcinoma (HCC).METHODS:The National Cancer Database was used to identify patients with advanced HCC diagnosed between January 1, 2017, and December 31, 2019. We included patients who received combined therapy or immunotherapy alone as first-line treatment. Multivariable logistic regression was conducted to determine predictors of combined therapy. Kaplan-Meier and Cox regression approaches were used to identify predictors of overall survival and to compare hazards of mortality between the patients who received combined therapy and immunotherapy alone.RESULTS:Of 1,664 eligible patients with advanced-stage HCC, 142 received combined TARE/immunotherapy and 1,522 received immunotherapy alone. Receipt of combination therapy was associated with care at an academic center and inversely associated with racial/ethnic minority status (Hispanic and Black individuals). The median overall survival was significantly higher in the combination group than in the immunotherapy alone group (19.8 vs 9.5 months). In multivariable analysis, combined therapy was independently associated with reduced mortality (adjusted hazard ratio 0.50, 95% confidence interval: 0.36-0.68, P < 0.001). Results were consistent across subgroups and in sensitivity analyses using propensity score matching and inverse probability of treatment weighting.DISCUSSION:The combination of TARE and immunotherapy was associated with improved survival compared with immunotherapy alone in patients with advanced-stage HCC. Our findings underly the importance of large clinical trials evaluating combination therapy in these patients.
KW - advanced hepatocellular carcinoma
KW - immunotherapy
KW - overall survival
KW - transarterial radioembolization
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U2 - 10.14309/ajg.0000000000002467
DO - 10.14309/ajg.0000000000002467
M3 - Article
C2 - 37561061
AN - SCOPUS:85178649366
SN - 0002-9270
VL - 118
SP - 2201
EP - 2211
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 12
ER -