Functional cure of hepatitis B in patients with cancer undergoing immune checkpoint inhibitor therapy.

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2024-07-29 DOI:10.1016/j.jhep.2024.07.018

Hsien-Chen Mon, Pei-Chang Lee, Yi-Ping Hung, Ya-Wen Hung, Chi-Jung Wu, Chieh-Ju Lee, Chen-Ta Chi, I-Cheng Lee, Ming-Chih Hou, Yi-Hsiang Huang

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Abstract

Background & aims: Immune checkpoint inhibitors (ICIs) can restore exhausted T cell immunity not only for cancer treatment but also potentially for curing chronic hepatitis B (CHB). The impact of ICIs on Hepatitis B surface antigen (HBsAg) seroclearance in cancer patients was unclear.

Methods: Consecutive cancer patients from 2016 to 2020 (Cohort 1, n=118), and hepatocellular carcinoma (HCC) patients from 2020 to 2022 (Cohort 2, n=44, as validation) receiving ICIs and positive for HBsAg were retrospectively recruited. An additional hepatitis B virus (HBV)-HCC cohort (Cohort 3, n=85) without ICI served as a control group. Factors associated with HBsAg loss or combining HBsAg decline >1 log were analyzed.

Results: With median follow-up of 17.5 months, 8 (6.8%) in cohort 1 and 4 (9.1%) in cohort 2 achieved HBsAg seroclearance, and additional 4 in cohort 1 and 1 in cohort 2 had HBsAg decline >1 log. In multivariate analysis, HBsAg <100 IU/mL was associated with HBsAg seroclearance (HR=6.274, p=0.028). In the validation cohort, the cumulative incidence of HBsAg loss at months 12 and 24 was 13.0% and 38.4% for baseline HBsAg <100 IU/ml, which were significantly higher than those in the control group (p=0.0267). While no case in cohort 3 achieved HBsAg within 24 months. Of the 17 cases achieved HBsAg loss and decline >1 log, 16 (94.1%) had nucleos(t)ide analogs treatment. The median time to HBsAg loss or HBsAg decline was 16.5 months (ranged 9.6 to 27.5).

Conclusions: ICIs may accelerate HBsAg seroclearance in cancer patients with baseline HBsAg <100 IU/ml. This finding provides important information for the design of future ICI trials to achieve functional cure in patients with CHB.

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接受免疫检查点抑制剂治疗的癌症患者的乙型肝炎功能性治愈。

背景与目的：免疫检查点抑制剂（ICIs）可恢复衰竭的T细胞免疫功能，不仅可用于癌症治疗，还可能用于慢性乙型肝炎（CHB）的治疗。ICIs对癌症患者乙肝表面抗原（HBsAg）血清清除率的影响尚不明确：回顾性招募了接受 ICIs 且 HBsAg 阳性的 2016 年至 2020 年连续癌症患者（队列 1，n=118）和 2020 年至 2022 年肝细胞癌（HCC）患者（队列 2，n=44，作为验证）。另一个未接受 ICI 的乙型肝炎病毒（HBV）-HCC 队列（队列 3，人数=85）作为对照组。分析了与HBsAg丢失或合并HBsAg下降>1 log相关的因素：中位随访 17.5 个月后，队列 1 中的 8 人（6.8%）和队列 2 中的 4 人（9.1%）实现了 HBsAg 清除，队列 1 中的另外 4 人和队列 2 中的 1 人 HBsAg 下降>1 log。在多变量分析中，HBsAg 下降 1 log 的患者中有 16 人（94.1%）接受了核苷（t）类似物治疗。HBsAg丢失或下降的中位时间为16.5个月（9.6至27.5个月不等）：ICIs可加速基线HBsAg为阳性的癌症患者的HBsAg血清清除。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.

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