Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1608
Peer-review started: April 15, 2022
First decision: May 12, 2022
Revised: May 27, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 27, 2022
Processing time: 132 Days and 20.5 Hours
Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. The landscape of the systemic treatment for advanced hepatocellular carcinoma (HCC) is changing quickly. However, frail patients with impaired liver function and poor performance status, who already received multiple treatment lines, are often excluded from randomized controlled trial’s and are ineligible for the standard of care. Nivolumab monotherapy has proven to be effective sometimes for advanced HCC, with a favorable safety profile, and hence nivolumab could be a valuable treatment option for these patients.
Given the recent fast evolutions in the systemic treatment of advanced HCC nowadays, this study is very topical. This article provides interesting information as a starting point for further research, e.g., on patient selection per treatment strategy.
We aimed in this study to evaluate the real-world effectiveness of nivolumab monotherapy in patients with advanced HCC who are not eligible for other treatment.
We conducted a retrospective, multicentric study including 29 patients with advanced HCC. All patients had had prior chemotherapy or were intolerant or ineligible for treatments. Data were retrieved from patients’ medical records. The outcome parameters that we evaluated were radiological response according to RECIST criteria, the biological response through the evolution of the alpha-fetoprotein level, and clinical response considering both the Child–Pugh score and the World Health Organization performance status. A safety profile was also reported. Statistical analysis was performed using the SPSS Statistics 27 statistical software package.
The radiological overall response rate (ORR) to nivolumab monotherapy was 24.1%. The biological ORR was 20.7%. Radiological and biological responses were significantly associated both with each other and with overall survival. Overall survival was 14.5 mo (+/- 2.1), and progression-free survival was 10.9 mo (+/- 2.3). We confirmed the favorable safety profile of nivolumab. We showed notably better results than reported in literature. Hence nivolumab monotherapy should be considered as a valuable treatment option in selected patients otherwise not eligible for systemic treatment. Further research is warranted to confirm these findings.
Nivolumab monotherapy is a good treatment choice in frail patients with HCC who are ineligible for the standard of care or other validated systemic treatments.
This article provides interesting information as a starting point for further research. Future research is warranted to confirm the good treatment response to nivolumab in a subgroup of patients with advanced HCC, and furthermore to define this subgroup of patients, to facilitate patient selection per treatment strategy.