Meta-analysis of clinical trials suggests that Immune checkpoint inhibitors (ICIs) may be more effective than the standard of care for patients with hepatocellular carcinoma (HCC). This idea is supported by a recent study published in the JAMA network open. This study compares the efficacy of ICIs vs standard of care by analysing data from three phase 3, randomised clinical trials (RCT): KEYNOTE-240, CheckMate-459, and IMbrave150; summing 1657 patients in total.
Hepatocellular carcinoma (HCC) is one of the most lethal malignant neoplasms, ranking as the fourth most common cause of cancer-related death in the world. Since 2008, sorafenib has been the standard of care for these cases. In recent years, ICIs like pembrolizumab, nivolumab or atezolizumab, have ushered in a new era in cancer therapy, but their efficacy in HCC is uncertain. In the KEYNOTE-240, patients with previously treated advanced HCC received second-line treatment with pembrolizumab + best supportive care (BSC), or BSC alone. In CheckMate-459 and IMbrave150, patients with advanced HCC received first-line treatment with nivolumab/sorafenib and sorafenib/atezolizumab + bevacizumab, respectively.
The overall survival (OS) was significantly improved in HCC patients who received ICIs than those on the standard of care (HR [95-%CI]: 0.75[0.62-0.92]; p=0.006). ICIs were also associated with better progression-free survival (PFS) (HR [95%-CI]: 0.74 [0.56-0.97]; p=0.03), and a better overall response rate (ORR) (OR [95%-CI]: 2.82[2.02-3.93]; p<0.001). The probability of adverse events (grade 3-4) was lower in patients who received ICIs than those with sorafenib (OR [95%-CI]: 0.44[0.20-0.96]; p=0.04).
This meta-analysis found superior efficacy and safety associated with ICIs compared with the standard of care . Therefore, these findings suggest that ICIs should become the new standard of care in systemic therapy of unresectable HCC.
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