Clinical Outcomes and Hepatic Toxicity of Combined Intensity Modulated Radiotherapy and PD-1 Inhibitors in Child-Pugh Class B Advanced Hepatocellular Carcinoma.

IF 4.4 Q1 IMMUNOLOGY
ImmunoTargets and Therapy Pub Date : 2025-09-12 eCollection Date: 2025-01-01 DOI:10.2147/ITT.S538796
Lijun Chen, Min Liu, Shenshen Chen, Yi Wu, Shichun Guan, Jianxu Li, Shixiong Liang
{"title":"Clinical Outcomes and Hepatic Toxicity of Combined Intensity Modulated Radiotherapy and PD-1 Inhibitors in Child-Pugh Class B Advanced Hepatocellular Carcinoma.","authors":"Lijun Chen, Min Liu, Shenshen Chen, Yi Wu, Shichun Guan, Jianxu Li, Shixiong Liang","doi":"10.2147/ITT.S538796","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>There is limited research data on the management of hepatocellular carcinoma (HCC) patients with Child-Pugh class B (CP-B). This study aimed to evaluate the clinical outcomes and radiation-induced hepatic toxicity (RIHT) of combined intensity modulated radiotherapy (IMRT) and programmed cell death protein 1 (PD-1) inhibitors in advanced HCC patients with CP-B.</p><p><strong>Patients and methods: </strong>This retrospective study screened 232 CP-B advanced HCC patients who had undergone IMRT, and the irradiation scopes were intrahepatic tumor lesions and/or venous tumor thrombosis. The propensity matching method (PSM) was used to reduce selection bias between the radiotherapy (RT) and RT+PD-1 groups. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoints included local progression-free survival (LPFS), out-of-field progression-free survival (outPFS), objective response rate (ORR), disease control rate (DCR), and RIHT.</p><p><strong>Results: </strong>50 and 39 patients with CP-B advanced HCC were included in the RT+PD-1 and RT groups. After PSM, 39 patients from each group were matched. The median follow-up duration was 15.53 months (95% CI, 13.83-17.22). The median OS and median PFS of RT+PD-1 group were significantly prolonged than RT group (OS:14.27 months [95% CI, 10.53-not estimable] vs 7.57 months [95% CI, 6.57-10.00], HR = 0.284; 95% CI, 0.153-0.526; p < 0.001), (PFS:9.00 months [95% CI, 5.00-not estimable] vs 4.50 months [95% CI, 3.10-6.00], HR = 0.349; 95% CI, 0.188-0.648; p < 0.001). The ORR of RT+PD-1 group was improved than RT group, 43.6% (95% CI, 27.3-59.9) vs 28.2% (95% CI, 13.4-43.0) (p = 0.157). The incidence of RIHT did not differ between the groups except the RT+PD-1 group experienced increased total bilirubin (≥grade 1) more frequently (p = 0.021).</p><p><strong>Conclusion: </strong>Combined IMRT and PD-1 inhibitors improved clinical outcomes with a comparable incidence of RIHT to radiotherapy alone in advanced HCC patients with CP-B. The individual combined IMRT and PD-1 inhibitors for CP-B could be cautiously applied weighing the survival benefits and the RIHT risks.</p>","PeriodicalId":30986,"journal":{"name":"ImmunoTargets and Therapy","volume":"14 ","pages":"1015-1028"},"PeriodicalIF":4.4000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439709/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ImmunoTargets and Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/ITT.S538796","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: There is limited research data on the management of hepatocellular carcinoma (HCC) patients with Child-Pugh class B (CP-B). This study aimed to evaluate the clinical outcomes and radiation-induced hepatic toxicity (RIHT) of combined intensity modulated radiotherapy (IMRT) and programmed cell death protein 1 (PD-1) inhibitors in advanced HCC patients with CP-B.

Patients and methods: This retrospective study screened 232 CP-B advanced HCC patients who had undergone IMRT, and the irradiation scopes were intrahepatic tumor lesions and/or venous tumor thrombosis. The propensity matching method (PSM) was used to reduce selection bias between the radiotherapy (RT) and RT+PD-1 groups. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoints included local progression-free survival (LPFS), out-of-field progression-free survival (outPFS), objective response rate (ORR), disease control rate (DCR), and RIHT.

Results: 50 and 39 patients with CP-B advanced HCC were included in the RT+PD-1 and RT groups. After PSM, 39 patients from each group were matched. The median follow-up duration was 15.53 months (95% CI, 13.83-17.22). The median OS and median PFS of RT+PD-1 group were significantly prolonged than RT group (OS:14.27 months [95% CI, 10.53-not estimable] vs 7.57 months [95% CI, 6.57-10.00], HR = 0.284; 95% CI, 0.153-0.526; p < 0.001), (PFS:9.00 months [95% CI, 5.00-not estimable] vs 4.50 months [95% CI, 3.10-6.00], HR = 0.349; 95% CI, 0.188-0.648; p < 0.001). The ORR of RT+PD-1 group was improved than RT group, 43.6% (95% CI, 27.3-59.9) vs 28.2% (95% CI, 13.4-43.0) (p = 0.157). The incidence of RIHT did not differ between the groups except the RT+PD-1 group experienced increased total bilirubin (≥grade 1) more frequently (p = 0.021).

Conclusion: Combined IMRT and PD-1 inhibitors improved clinical outcomes with a comparable incidence of RIHT to radiotherapy alone in advanced HCC patients with CP-B. The individual combined IMRT and PD-1 inhibitors for CP-B could be cautiously applied weighing the survival benefits and the RIHT risks.

Abstract Image

Abstract Image

调强放疗联合PD-1抑制剂治疗Child-Pugh B级晚期肝细胞癌的临床疗效和肝毒性
目的:关于Child-Pugh B级(CP-B)肝细胞癌(HCC)患者治疗的研究数据有限。本研究旨在评估调强放疗(IMRT)和程序性细胞死亡蛋白1 (PD-1)抑制剂联合治疗晚期HCC伴CP-B患者的临床结果和辐射诱导肝毒性(right)。患者和方法:本回顾性研究筛选了232例接受IMRT治疗的CP-B晚期HCC患者,照射范围为肝内肿瘤病变和/或静脉肿瘤血栓形成。采用倾向匹配法(PSM)减少放疗组与放疗+PD-1组之间的选择偏倚。主要终点是总生存期(OS)和无进展生存期(PFS),次要终点包括局部无进展生存期(LPFS)、野外无进展生存期(outPFS)、客观缓解率(ORR)、疾病控制率(DCR)和right。结果:RT+PD-1组和RT组分别纳入CP-B晚期HCC患者50例和39例。经PSM后,两组各配对39例。中位随访时间为15.53个月(95% CI, 13.83-17.22)。RT+PD-1组的中位OS和中位PFS明显延长于RT组(OS:14.27个月[95% CI, 10.53-不可估计]vs 7.57个月[95% CI, 6.57-10.00], HR = 0.284; 95% CI, 0.153-0.526, p < 0.001), (PFS:9.00个月[95% CI, 5.00-不可估计]vs 4.50个月[95% CI, 3.10-6.00], HR = 0.349; 95% CI, 0.181 -0.648, p < 0.001)。RT+PD-1组的ORR较RT组改善,分别为43.6% (95% CI, 27.3 ~ 59.9)和28.2% (95% CI, 13.4 ~ 43.0) (p = 0.157)。除了RT+PD-1组总胆红素(≥1级)升高更频繁(p = 0.021)外,各组间right的发生率无差异。结论:联合IMRT和PD-1抑制剂改善了晚期HCC伴CP-B患者的临床结果,且right的发生率与单独放疗相当。单独联合IMRT和PD-1抑制剂治疗CP-B可以谨慎地权衡生存获益和right风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
16.50
自引率
0.00%
发文量
7
审稿时长
16 weeks
期刊介绍: Immuno Targets and Therapy is an international, peer-reviewed open access journal focusing on the immunological basis of diseases, potential targets for immune based therapy and treatment protocols employed to improve patient management. Basic immunology and physiology of the immune system in health, and disease will be also covered.In addition, the journal will focus on the impact of management programs and new therapeutic agents and protocols on patient perspectives such as quality of life, adherence and satisfaction.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信