Patients with uHCC and Child-Pugh B8/9 also benefit from a combination of antiangiogenic agents and PD-1 inhibitors: a multicenter real-world study

Authors

  • Xiaoyan Ding Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Xue Yin Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Linlin Zheng Jinan Eco-environmental Monitoring Center of Shandong Province, Jinan, Shandong Province, China
  • Lin Zhou Department of Interventional Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
  • Junke Hu Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Wei Sun Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Lei Sun Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Yanjun Shen Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Ying Teng Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Yawen Xu Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Wendong Li Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • Mei Liu Department of Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
  • Jinglong Chen Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China

DOI:

https://doi.org/10.2340/1651-226X.2025.42652

Keywords:

Hepatocellular Carcinoma, Lenvatinib, Sorafenib, Immune Checkpoint Inhibitors, Child-Pugh B

Abstract

Background and purpose: Patients with unresectable hepatocellular carcinoma (uHCC) and Child-Pugh grade B face limited treatment options and poor outcomes. This study aims to evaluate whether the effect and safety of combining tyrosine kinase inhibitors (TKIs) with progressive disease (PD)-1 inhibitors in uHCC patients with Child-Pugh B7 (CP7) and B8/9 (CP8/9) differ.

Methods: This multicenter retrospective study included 179 uHCC patients with Child-Pugh B (CP7 group: n = 106; CP8/9 group: n = 73), receiving a combination of lenvatinib/sorafenib/other TKIs and PD-1 inhibitors between December 2020 and March 2023. Progression-free survival (PFS) and overall survival (OS) were defined as the primary endpoint. Secondary endpoints included the objective response rate (ORR) and safety.

Results: The median PFS and OS for the entire cohort were 7.3 months (95% confidence intervals [CI]: 6.3–8.3) and 16.0 months (95% CI: 12.9–19.1), respectively. No statistically significant differences were observed between CP7 and CP8/9 groups in PFS (7.8 vs. 6.3 months, p = 0.28), OS (17.8 vs. 14.0 months, p = 0.20), ORR (33.0% vs. 27.4%, p = 0.42), or safety profiles. However, the CP8/9 group had significantly higher rates of TKI dose reductions (46.6% vs. 31.1%, p = 0.04) and discontinuations (57.5% vs. 24.5%, p < 0.001). Notably, 30.2% of patients maintained sustained radiographic responses despite advanced liver dysfunction.

Interpretation: Combining TKIs with PD-1 inhibitors is an effective and well-tolerated option for HCC patients with Child-Pugh B, including those with CP8/9.

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Published

2025-05-05

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Ding, X., Yin, X., Zheng, L., Zhou, L., Hu, J., Sun, W., … Chen, J. (2025). Patients with uHCC and Child-Pugh B8/9 also benefit from a combination of antiangiogenic agents and PD-1 inhibitors: a multicenter real-world study. Acta Oncologica, 64, 607–615. https://doi.org/10.2340/1651-226X.2025.42652

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Vol. 64 (2025): Acta Oncologica

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Original article

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Copyright (c) 2025 Xiaoyan Ding, Xue Yin, Linlin Zheng, Lin Zhou, Junke Hu, Wei Sun, Lei Sun, Yanjun Shen, Ying Teng, Yawen Xu, Wendong Li, Mei Liu, Jinglong Chen

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This work is licensed under a Creative Commons Attribution 4.0 International License.