CRAFITY score as a predictive marker for refractoriness to atezolizumab plus bevacizumab therapy in hepatocellular carcinoma: a multicenter retrospective study
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Although atezolizumab plus bevacizumab (Atezo/Bev) therapy has been used as the preferred first-line treatment for advanced hepatocellular carcinoma (HCC), up to 26% of patients do not achieve disease control, suggesting alternative treatments might be more beneficial for such patients. We investigated key predictors for refractoriness to Atezo/Bev therapy, particularly in the first-line setting. METHODS: We retrospectively analyzed 302 patients with HCC who received Atezo/Bev therapy between October 2020 and September 2022 across nine hospitals in Japan. Refractoriness was defined as best overall response (BOR) of progressive disease or stable disease and a progression-free survival (PFS) of < 180 days (RECIST v1.1). Clinical benefit was defined as BOR of partial/complete response or stable disease with PFS of ≥ 180 days. Baseline characteristics and potential predictors, identified through literature review, were compared between these groups. Stratifications of overall survival (OS), and PFS were also assessed. RESULTS: Refractoriness was observed in 126 (41.7%) patients, while 154 (51.0%) achieved clinical benefit. Due to a significant association between the treatment line and refractory rate, the subsequent analysis focused on the first-line cohort (n = 214; 72 [33.6%] patients showed refractoriness). Among 13 potential predictors, the CRP and AFP in immunotherapy (CRAFITY) score had the best predictive performance, with refractory rates of 24.6%, 44.6%, and 57.9% in CRAFITY-0, 1, and 2 patients, respectively (p < 0.001). OS and PFS were also well-stratified by this scoring system. CONCLUSIONS: Approximately one-third of patients were refractory to first-line Atezo/Bev therapy. The CRAFITY score demonstrated superior performance in predicting refractoriness.
Source: Journal of Gastroenterology
Authors: Masayuki Ueno, Haruhiko Takeda, Atsushi Takai, Hiroki Morimura, Norihiro Nishijima, Satoru Iwamoto, Shunsuke Okuyama, Makoto Umeda, Takeshi Seta, Atsuyuki Ikeda, Tomoyuki Goto, Shin’ichi Miyamoto, Takahisa Kayahara, Yoshito Uenoyama, Kazuyoshi Matsumura, Shigeharu Nakano, Masako Mishima, Tadashi Inuzuka, Yuji Eso, Ken Takahashi, Hiroyuki Marusawa, Yukio Osaki, Etsuro Hatano, Hiroshi Seno
Institutions: Kyoto University, Kurashiki Central Hospital, Osaka Red Cross Hospital, Meiwa Hospital, Kyoto Medical Center, Hyogo Prefectural Amagasaki General Medical Center, Japanese Red Cross Society Wakayama Medical Center, Kyoto Katsura Hospital, Center for Cancer Immunotherapy and Immunobiology, Kyoto University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,990
OpenAlex ID: W4402600971