Immune-related AEs linked to better outcomes in HCC patients

Patients with hepatocellular carcinoma (HCC) who develop immune-related adverse events (irAEs) following treatment with an immune checkpoint inhibitor (ICI) tend to have more favourable clinical outcomes, including better progression free survival (PFS) and objective response rate (ORR), reports a recent study.

A team of investigators searched the databases of PubMed, Scopus, Web of Science, and Central Register of Controlled Trials. They identified articles published from inception to June 2024 using keywords such as ICI, HCC, and irAEs. Statistical analysis was also conducted using a random effects model.

A total of 3,028 studies were identified, of which 24 (n=4,127 patients) met the eligibility criteria. The most common treatment regimen used was atezolizumab plus bevacizumab (n=10 studies).

The development of irAEs significantly correlated with an increased ORR (pooled relative ratio [RR], 1.73, 95 percent confidence interval [CI], 1.36‒2.21; I², 41 percent), a higher disease control rate (pooled RR, 1.45, 95 percent CI, 1.21‒1.74; I², 74 percent), and longer PFS (pooled hazard ratio [HR], 0.66, 95 percent CI, 0.52‒0.84k; I², 71 percent).

A trend toward longer overall survival was observed among patients with irAEs relative to those without (pooled HR, 0.84, 95 percent CI, 0.63‒1.12; I², 73 percent).

In subgroup analysis, patients with grade 1‒2 irAEs (pooled HR, 0.50, 95 percent CI, 0.36‒0.67; I², 0 percent) and those with endocrine irAEs (pooled HR, 0.63, 95 percent CI, 0.48‒0.83; I², 12 percent) enjoyed survival benefits.

“Overall survival benefit was noted in patients with mild irAEs but not those with severe irAEs,” the investigators said.