Locoregional treatment improves overall survival for liver cancer during second-line regorafenib or immune checkpoint inhibitor

Po-Ting Lin; Yu-Chun Hsu; Yu-Ting Kao; Wei Teng; Yi-Chung Hsieh; Wei-Ting Chen; Chung-Wei Su; Ching-Ting Wang; Pei-Mei Chai; Chen-Chun Lin; Chun-Yen Lin; Shi-Ming Lin

doi:10.62347/GFVP1262

Locoregional treatment improves overall survival for liver cancer during second-line regorafenib or immune checkpoint inhibitor

Am J Cancer Res. 2024 Mar 15;14(3):1306-1315. doi: 10.62347/GFVP1262. eCollection 2024.

Authors

Po-Ting Lin^{1

2

3}, Yu-Chun Hsu^{1

2}, Yu-Ting Kao^{1

2}, Wei Teng^{1

2}, Yi-Chung Hsieh^{1

2}, Wei-Ting Chen^{1

2}, Chung-Wei Su^{1

2}, Ching-Ting Wang^{2

4}, Pei-Mei Chai^{2

4}, Chen-Chun Lin^{2

5}, Chun-Yen Lin^{1

2}, Shi-Ming Lin^{1

2}

Affiliations

¹ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch Taoyuan 333, Taiwan.
² College of Medicine, Chang Gung University Taoyuan 333, Taiwan.
³ Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University Taoyuan 333, Taiwan.
⁴ Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center Taoyuan 333, Taiwan.
⁵ Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital New Taipei 236, Taiwan.

Abstract

For advanced hepatocellular carcinoma (HCC), the best second-line treatment after first-line treatment with sorafenib is unclear. This study aimed to compared the efficacy of second-line regorafenib (a tyrosine kinase inhibitor) and immune checkpoint inhibitors (ICIs) in patients with advanced HCC after sorafenib therapy. This retrospective study included 89 patients with HCC treated with sorafenib, and then regorafenib (n = 58) or an ICI (n = 31). Treatment response, overall survival (OS) and progression-free survival (PFS) of the 2 groups were compared, and factors associated with post-treatment mortality or disease progression were evaluated. During follow-up period, compared to regorafenib, treatment with an ICI results in a slight increase in a 20% decrease of AFP (35.7% vs. 31.8%), complete response rate (6.5% vs. 0%), objective response rate (16.1% vs. 6.9%), median overall survival (13.3 vs. 5 months), and median PFS (3.0 vs. 2.6 months). Combined locoregional treatment (LRT) (hazard ratio [HR] = 0.40, 95% confidence interval [CI]: 0.15-0.99) during second-line treatment was associated with a decreased risk of post-treatment mortality. After propensity scoring matching, combined LRT during second-line treatment had longer post-treatment OS than patients without combined LRT. A 20% decrease of AFP (HR = 0.54, 95% CI: 0.31-0.94) was associated with a decreased risk of post-treatment disease progression. In conclusions, second-line treatment with regorafenib or ICI prolongs OS in patients with advanced HCC treated with sorafenib. Combined LRT during second-line treatment is associated with decreased post-treatment mortality. A 20% decrease of AFP level may be predictive of a lower rate of disease progression.

Keywords: Combination therapy; hepatocellular carcinoma (HCC); immune checkpoint inhibitor (ICI); locoregional treatment (LRT); regorafenib; second-line treatment; sorafenib.