The University of Hong Kong, Hong Kong, NA, Hong Kong
Chi Leung Chiang , Stephen Lam Chang , Sik-Kwan Chan , Ann Shing Lee , Keith Wan Hang Chiu , Vanessa Ting Yan Yeung , Natalie Sean Man Wong , Venus Wan Yan Lee , Vince Wing Hang Lau , Nancy Kwan Man , Feng-Ming Spring Kong , Albert Chi Yan Chan
Background: Sequential transarterial chemoembolization and stereotactic body radiotherapy followed by immunotherapy (IO) (START-FIT) using anti-PD-L1 has demonstrated promising efficacy in locally advanced HCC (laHCC). We aimed to evaluate START-FIT activity using anti-PD-L1 and anti-CTLA-4 IO backbone. Methods: Adult patients with laHCC not suitable for curative resections were recruited. Each with tumor at least 5cm, maximum three tumors, and child-Pugh A5-B7 liver function. Patients had single TACE, 5-SBRT 28 days after, then single Tremelimumab (300mg) and regular 4-week interval Durvalumab (1500mg) at 7 days upon SBRT completion. Primary endpoint was overall response rate (ORR) per modified Response Evaluation Criteria in Solid Tumors (mRECIST); secondary endpoints included progression-free survival (PFS), overall survival (OS), and treatment-related (TR) adverse event (AE) [NCT04988945]. Results: During 11 Dec, 20 and 3 Oct, 22, 16 patients were enrolled with median age 66 (range (r): 51–84 years), 14 (87.5%) were male, the lesion(s) diameter median sum was 11.2 cm (r: 5.8–15cm), and 11 (68.8%) had macrovascular invasion (n=6, hepatic vein, n=4, branched portal vein, n=1 both). With median 11.3 months (r: 3.7–24.5 months) follow-up time, the best ORR was 81.3% (95% CI: 54.4–96.0%) (Complete response CR: n=7, 43.8%; partial response PR: n=6, 37.5%; static disease SD + progressive disease PD: n=3, 18.7%). The 6 and 12-month PFS rates was 86.7% (95% CI: 69.3–100%) and 58.7% (95% CI: 33.6–84.4%), while 6 and 12-month OS rates was 100% (95% CI: 91.7–100%) and 83.3% (95% CI: 62.2–100%) respectively. The 12-month OS with CR vs. PR vs. SD+PD was 100%, 75%, and 50% respectively. Four (25%) and one patient (6.3%) experienced TRAEs and immune-related AE of grade 3 or worse respectively. Conclusions: START-FIT using STRIDE is safe and effective in unresectable laHCC resulted in 43.8% CR rate and promising survival. Clinical trial information: NCT04988945.
N=16 | % | |
---|---|---|
Age, median (r), years | 66 (51–84) | |
Sex Male Female | 14 2 | 87.5 12.5 |
ECOG performance status 0 1 | 12 4 | 75 25 |
Aetiology of liver cirrhosis Hepatitis B Multiple etiologies Cryptogenic | 12 2 2 | 75 12.5 12.5 |
Child-Pugh score A5 A6 | 12 4 | 75 25 |
Albumin Bilirubin Score Grade 1 Grade 2 | 11 5 | 68.7 31.3 |
BCLC stage A-B C without extra-hepatic spread | 5 11 | 31.3 68.7 |
Unresectable Reasons Inadequate liver remnant volume and / or poor ICG Unable to achieve R0 resection BCLC stage C without extra-hepatic spread | 4 1 11 | 25 6.3 68.7 |
Tumor vascular invasion No Yes Branched portal vein invasion Hepatic vein invasion Both | 5 11 4 6 1 | 31.3 68.7 25 37.4 6.3 |
Number of lesion(s) 1 2-3 | 14 2 | 87.5 12.5 |
Largest lesion size, median (r), cm | 10.8 (5.8–15) | |
Sum of largest lesion diameters, median (r), cm | 11.2 (5.8–15) | |
Baseline AFP, ng/ml ≤ 400 > 400 | 11 5 | 68.8 31.2 |
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Abstract Disclosures
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First Author: Chi Leung Chiang
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