Zhou JM, Xiong HF, Chen XP, Zhang ZW, Zhu LP, Wu B. Correlation between immune-related adverse events and long-term outcomes in pembrolizumab-treated patients with unresectable hepatocellular carcinoma: A retrospective study. World J Gastrointest Oncol 2023; 15(4): 689-699 [PMID: 37123056 DOI: 10.4251/wjgo.v15.i4.689]
Corresponding Author of This Article
Biao Wu, MD, Doctor, Department of Hepatobiliary Surgery, Wuhan Hospital of Traditional Chinese and Western Medicine, No. 215 Zhongshan Avenue, Qiaokou District, Wuhan 430030, Hubei Province, China. wuhanyywb@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Apr 15, 2023; 15(4): 689-699 Published online Apr 15, 2023. doi: 10.4251/wjgo.v15.i4.689
Correlation between immune-related adverse events and long-term outcomes in pembrolizumab-treated patients with unresectable hepatocellular carcinoma: A retrospective study
Jiang-Min Zhou, Li-Ping Zhu, Biao Wu, Department of Hepatobiliary Surgery, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan 430030, Hubei Province, China
Hui-Fang Xiong, Department of Digestive Medicine, Dongxihu District People’s Hospital, Wuhan 430030, Hubei Province, China
Xiao-Ping Chen, Zhi-Wei Zhang, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Zhou JM and Xiong HF analyzed the data and wrote the manuscript; Zhu LP, Zhang ZW, and Chen XP designed the research; Wu B modified the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Ethical Committee of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology. All procedures performed in this study abided by the Declaration of Helsinki.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets (data) for this study can be found in the (figure) https://figshare.com/s/ee63fa5271448d51104e. The other datasets were available on request from the corresponding author at wuhanyywb@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Biao Wu, MD, Doctor, Department of Hepatobiliary Surgery, Wuhan Hospital of Traditional Chinese and Western Medicine, No. 215 Zhongshan Avenue, Qiaokou District, Wuhan 430030, Hubei Province, China. wuhanyywb@163.com
Received: October 26, 2022 Peer-review started: October 26, 2022 First decision: December 14, 2022 Revised: December 16, 2022 Accepted: March 23, 2023 Article in press: March 23, 2023 Published online: April 15, 2023 Processing time: 167 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background
Unresectable hepatocellular carcinoma (HCC).
Research motivation
Immune-related adverse events (irAEs) have a high incidence in immune checkpoint inhibitor (ICI) treatment of unresectable HCC. The relationship between irAEs and treatment outcomes in ICI-treated unresectable HCC patients remains unknown.
Research objectives
A retrospective study was conducted to elucidate the correlation between immune-related toxic effects and prognosis in patients with unresectable HCC treated with pembrolizumab.
Research methods
A total of 190 unresectable HCC (Barcelona Clinic Liver Cancer stage C) patients receiving pembrolizumab treatment were retrospectively reviewed. All irAEs were reviewed and the relationship between irAEs and prognosis was analyzed.
Research results
In our study, we found that the overall incidence of irAEs was 72.6% (138/190) and 10.0% of them were severe irAEs (grade ≥ 3); elevated transaminase (> 3 times upper limit of normal) was the most common adverse reaction to ICIs. Patients who developed myocarditis or hypothyroidism tended to achieve partial response and have a more significant decrease in tumor burden. In addition, patients without irAEs were more likely to have progressive disease. It suggested that irAEs are indeed closely related to antitumor effects. In addition, hypothyroidism was the independent risk factors for time to progression and overall survival.
Research conclusions
irAEs, especially hypothyroidism, could be used as an indicator to evaluate the effect of immunotherapy.
Research perspectives
The study could help doctors in identifying patients who are responding to immunotherapy. In general, the response rate to both tyrosine kinase inhibitors and ICIs is less than 30%. Serious adverse events may put patients at risk of death. Therefore, timely identification of the right patients can not only reduce the side effects of immunotherapy but also improve the effectiveness of treatment.
