Journal of Hepatocellular Carcinoma (Feb 2024)

Immunotherapy Efficacy in Advanced Hepatocellular Carcinoma in a Diverse and Underserved Population in the United States

  • Bteich F,
  • Desai K,
  • Zhang C,
  • Kaur A,
  • Levy RA,
  • Bioh L,
  • Wang A,
  • Sultana S,
  • Kaubisch A,
  • Kinkhabwala M,
  • Bellemare S,
  • Fidvi S,
  • Kanmaniraja D,
  • Berkenblit R,
  • Moon JY,
  • Adedimeji A,
  • Tow CY,
  • Saenger Y

Journal volume & issue
Vol. Volume 11
pp. 257 – 269

Abstract

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Fernand Bteich,1 Kush Desai,1 Chenxin Zhang,1,2 Anahat Kaur,3 Rachel A Levy,1 Lydia Bioh,1 Aaron Wang,1 Sharmin Sultana,1 Andreas Kaubisch,1 Milan Kinkhabwala,1,4 Sarah Bellemare,1,4 Shabnam Fidvi,5 Devaraju Kanmaniraja,5 Robert Berkenblit,5 Jee-Young Moon,1,2 Adebola Adedimeji,2 Clara Y Tow,6 Yvonne Saenger1 1Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA; 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 3Department of Medicine, Division of Medical Oncology, Jacobi Medical Center, Bronx, NY, USA; 4Department of General Surgery, Division of Abdominal Transplantation, Montefiore Medical Center, Bronx, NY, USA; 5Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA; 6Department of Medicine, Division of Transplant Hepatology, Montefiore Medical Center, Bronx, NY, USACorrespondence: Yvonne Saenger, Montefiore Einstein Comprehensive Cancer Center, Department of Oncology, Albert Einstein College of Medicine, Golding Building, Room 701, 1300 Morris Park Avenue, Bronx, NY, 10461, USA, Tel +1 718-430-2715, Email [email protected]: : Incidence of hepatocellular cancer (HCC) in the Bronx is 61% higher than the rest of New York State. Underserved populations are not well represented in clinical trials of immune checkpoint inhibitors (ICI).Methods: Demographics were tabulated for 194 patients treated with ICI at the Montefiore-Einstein Comprehensive Cancer Center (MECCC) between 2017 and 2022. Categorical variables were analyzed by Chi-squared test, and survival was analyzed using Kaplan–Meier (KM) curves.Results: MECCC patients were 40.7% Hispanic and 20.6% Black, compared with 3% and 2%, respectively, in the landmark IMbrave 150 study. Median overall survival (mOS) on ICI was 9.0 months, 25.0 months for the 100 (51.5%) favorable-prognosis Child Pugh A (CPA) patients included in HCC clinical trials. Disease control rate (DCR) was 58.5% among 123 evaluable patients per mRECIST 1.1. Baseline liver function, as defined by CP and the Model for End-Stage Liver Disease-Sodium (MELD-Na), correlated with survival (p < 0.001). Hepatitis C Virus (HCV) and alcoholism were over-represented relative to National Cancer Institute (NCI) data (56.2% vs 4.7% and 38.7% vs 8.2%, respectively). HCV treatment correlated with prolonged survival in infected patients (p = 0.0017). AFP decline correlated with response (p = 0.001). Hispanic patients lived longer when clinical variables were controlled for (mOS 52 vs 23 months; p = 0.011).Conclusion: In an underserved HCC population, ICI yielded a DCR of 58.5% and low rates of severe toxicity. This work highlights ICI efficacy in minority groups, a need for earlier HCC diagnosis and for studies of genetic and environmental factors in Hispanics with HCC.Keywords: hepatocellular carcinoma, systemic therapy, immunotherapy, checkpoint inhibitors, minorities

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