CRAFITY score as a predictive marker for refractoriness to atezolizumab plus bevacizumab therapy in hepatocellular carcinoma: a multicenter retrospective study

IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastroenterology Pub Date : 2024-09-18 DOI:10.1007/s00535-024-02150-7
Masayuki Ueno, Haruhiko Takeda, Atsushi Takai, Hiroki Morimura, Norihiro Nishijima, Satoru Iwamoto, Shunsuke Okuyama, Makoto Umeda, Takeshi Seta, Atsuyuki Ikeda, Tomoyuki Goto, Shin’ichi Miyamoto, Takahisa Kayahara, Yoshito Uenoyama, Kazuyoshi Matsumura, Shigeharu Nakano, Masako Mishima, Tadashi Inuzuka, Yuji Eso, Ken Takahashi, Hiroyuki Marusawa, Yukio Osaki, Etsuro Hatano, Hiroshi Seno
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Abstract

Background

Although atezolizumab plus bevacizumab (Atezo/Bev) therapy has been used as the preferred first-line treatment for advanced hepatocellular carcinoma (HCC), up to 26% of patients do not achieve disease control, suggesting alternative treatments might be more beneficial for such patients. We investigated key predictors for refractoriness to Atezo/Bev therapy, particularly in the first-line setting.

Methods

We retrospectively analyzed 302 patients with HCC who received Atezo/Bev therapy between October 2020 and September 2022 across nine hospitals in Japan. Refractoriness was defined as best overall response (BOR) of progressive disease or stable disease and a progression-free survival (PFS) of < 180 days (RECIST v1.1). Clinical benefit was defined as BOR of partial/complete response or stable disease with PFS of ≥ 180 days. Baseline characteristics and potential predictors, identified through literature review, were compared between these groups. Stratifications of overall survival (OS), and PFS were also assessed.

Results

Refractoriness was observed in 126 (41.7%) patients, while 154 (51.0%) achieved clinical benefit. Due to a significant association between the treatment line and refractory rate, the subsequent analysis focused on the first-line cohort (n = 214; 72 [33.6%] patients showed refractoriness). Among 13 potential predictors, the CRP and AFP in immunotherapy (CRAFITY) score had the best predictive performance, with refractory rates of 24.6%, 44.6%, and 57.9% in CRAFITY-0, 1, and 2 patients, respectively (p < 0.001). OS and PFS were also well-stratified by this scoring system.

Conclusions

Approximately one-third of patients were refractory to first-line Atezo/Bev therapy. The CRAFITY score demonstrated superior performance in predicting refractoriness.

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将 CRAFITY 评分作为肝细胞癌阿特珠单抗加贝伐单抗治疗难治性的预测指标:一项多中心回顾性研究
背景尽管阿特珠单抗加贝伐单抗(Atezo/Bev)疗法已被用作晚期肝细胞癌(HCC)的首选一线治疗方法,但仍有高达26%的患者未能实现疾病控制,这表明替代疗法可能对这类患者更有益。我们研究了Atezo/Bev治疗难治性的关键预测因素,尤其是在一线治疗中。方法我们回顾性分析了2020年10月至2022年9月期间在日本9家医院接受Atezo/Bev治疗的302例HCC患者。难治性的定义是疾病进展或疾病稳定的最佳总反应(BOR)和< 180天的无进展生存期(PFS)(RECIST v1.1)。临床获益定义为部分/完全应答或病情稳定且 PFS ≥ 180 天。通过文献综述确定的基线特征和潜在预测因素在这些组别之间进行了比较。结果 126 例(41.7%)患者出现耐药,154 例(51.0%)患者获得临床获益。由于治疗线与难治率之间存在显著关联,后续分析主要集中在一线队列(n = 214;72 [33.6%]患者出现难治)。在 13 个潜在预测因子中,免疫治疗中的 CRP 和 AFP(CRAFITY)评分的预测效果最好,CRAFITY-0、1 和 2 患者的难治率分别为 24.6%、44.6% 和 57.9%(p <0.001)。结论约三分之一的患者对一线 Atezo/Bev 治疗难治。CRAFITY评分在预测难治性方面表现优异。
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来源期刊
Journal of Gastroenterology
Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
12.20
自引率
1.60%
发文量
99
审稿时长
4-8 weeks
期刊介绍: The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.
期刊最新文献
Publisher Correction: CRAFITY score as a predictive marker for refractoriness to atezolizumab plus bevacizumab therapy in hepatocellular carcinoma: a multicenter retrospective study. Alcohol-associated liver disease increases the risk of muscle loss and mortality in patients with cirrhosis. Small extracellular vesicles derived from adipose mesenchymal stem cells alleviate intestinal fibrosis by inhibiting the FAK/Akt signaling pathway via MFGE8. Response to letter to the editor regarding: "Alcohol-associated liver disease increases the risk of muscle reduction and mortality in patients with cirrhosis". Association of circulating cytokine levels and tissue-infiltrating myeloid cells with achalasia: results from Mendelian randomization and validation through clinical characteristics and single-cell RNA sequencing.
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