Outcomes of tyrosine kinase inhibitors (TKI) after immunotherapy in unresectable or advanced hepatocellular carcinoma (HCC) patients.

Authors

null

Thomas Cheung Yau

Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong

Thomas Cheung Yau , Vikki Tang , Jess Chan , Gin Wai Kwok , Joanne Chiu , Roland Ching-Yu Leung , Bryan Li , Tan To Cheung

Organizations

Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong

Research Funding

Pharmaceutical/Biotech Company

Background: The outcomes of tyrosine kinase inhibitor(TKI) treatment after immune checkpoint inhibitors (PD-1i, PD-L1i, CTLA-4i) in unresectable/advanced HCC population is largely unknown. Methods: Retrospective analysis of advanced HCC patients treated with immune checkpoint inhibitors followed by TKI therapy at Queen Mary Hospital, Hong Kong were reviewed for the outcomes. Patients received locoregional therapy immediately after immunotherapy were excluded. Results: From January 2016 to July 2018, 30 HCC patients (83% of HBV, 80% of Child Pugh A, 83% of EHS/ MVI, median AFP=1,353ng/mL) who received TKI (11 lenvatinib, 10 sorafenib, 6 regorafenib, 3 axitinib) after immunotherapy were identified. TKI post-immunotherapy ("index TKI") was administered as third-line or beyond in 70% of patients. At the time of analysis (September 2018), median duration of index TKI was 72 days (IQR 36-119∗) (∗3 patients were still receiving TKI). AFP declined in 53% of patients and the median change from baseline to nadir was -25% (IQR -65% to +6%). 40% of patients received subsequent systemic therapy. Median OS from index TKI was 602 days (95%CI 124-not reached; death event rate: 47%). 3 patients achieved partial response to TKI and they had at least stable disease with the previous immunotherapy. No unexpected safety issues of TKI and death related to adverse events were noted (table). Conclusions: TKI is active with good tolerabilty following immunotherapy in advanced HCC patients.

TEAE (from start of index TKI)

G1G2G3G4
General
Hypertension7%33%7%0%
HFSR13%23%3%-
Malaise30%7%--
Diarrhea10%17%7%0%
Rash, unspecified23%0%3%0%
Nausea20%0%3%-
Hyponatremia3%-17%0%
Anorexia13%7%0%0%
Bleeding0%10%0%0%
Hypothyroidism0%7%0%0%
Oral mucositis0%7%0%0%
Vomiting7%0%0%0%
Weight loss7%0%0%0%
Liver function
Hypoalbuminemia40%20%7%0%
Hyperbilirubinemia23%13%13%3%
ALT increased23%13%13%0%
Hematological
Neutropenia10%10%13%0%
Thrombocytopenia17%13%3%0%
Anemia0%10%13%0%

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Abstract Details

Meeting

2019 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Sub Track

Multidisciplinary Treatment

Citation

J Clin Oncol 37, 2019 (suppl 4; abstr 361)

DOI

10.1200/JCO.2019.37.4_suppl.361

Abstract #

361

Poster Bd #

K1

Abstract Disclosures