Predictors of response to immunotherapy in patients with hepatocellular carcinoma - a retrospective single-center experience

Background While immunotherapy (IT) in combination with anti-angiogenic therapy will soon be the new standard-of-care for treatment of advanced hepatocellular carcinoma (HCC), still less than one-third of patients show objective response (defined as partial or complete response). Thus, we aimed to evaluate potential predictors of objective response in HCC patients treated with IT.

Methods Retrospective assessment of derived neutrophil to lymphocyte ratio (dNLR) as a marker of treatment response to IT with nivolumab or pembrolizumab in HCC patients treated at the Vienna General Hospital between 06/2016 and 02/2020

Results In total, 23 patients (n = 19, 83 % male; age: 64 ± 15 years) with intermediate and advanced HCC (BCLC B: n = 5, C: n = 17, D: n = 1) received IT (Pembrolizumab: n = 19, Nivolumab: n = 4). Median time-to-progression (TTP) was 6.5 (95 % confidence interval (CI):0.3-12.8) months, median progression-free survival (PFS) was 5.7 (95 %CI:0.4-11.0) months and median overall survival (OS) was 22.1 (95 %CI:9.0-35.2) months. When using a Youden-optimized cut-off (for OS; ≤ vs.  > 1.76), patients with a dNLR below this cut-off at baseline showed both a better objective response rate (50 % vs. 9 %;p = 0.11) and a longer OS (28.0 (95 %CI:not evaluable) vs. 11.1 (95 %CI:2.2-20.0) months; p = 0.091). Interestingly, patients with C-reactive protein (CRP) level  < 1mg/dL at baseline also showed a numerically improved ORR (36 % vs. 11 %;p = 0.319) which was associated with a significantly longer OS (23.1 (95 %CI:20.0-26.2) vs. 7.0 (95 %CI:4.5-9.4) months; p = 0.008).

Conclusions IT represents a promising treatment option for patients with advanced HCC. Inflammation seems to play an important role in HCC outcome and markers of inflammation may allow response prediction and potentially patient selection for IT.

Publication History

Article published online:
26 May 2020