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Trajectories of α-fetoprotein and unresectable hepatocellular carcinoma outcomes receiving atezolizumab plus bevacizumab: a secondary analysis of IMbrave150 study

British Journal of Cancer volume 129, pages 620–625 (2023)Cite this article

Subjects

Abstract

Background

α-fetoprotein (AFP) response has been demonstrated as a biomarker for unresectable hepatocellular carcinoma (uHCC) patients receiving immunotherapy, but its definition is still unclear. This exploratory study investigated the AFP trajectory and clinical outcomes of receiving atezolizumab plus bevacizumab (Atez/Bev) therapy.

Methods

This secondary analysis used the Atez/Bev arm data of phase III IMbrave150 study to distinguish potential AFP changing rate trajectories through latent class trajectory models. The multivariable Cox models were applied to calculate adjusted hazard ratios (HRs) and 95% CIs for clinical outcomes.

Results

Three distinct trajectories were identified among the uHCC patients with 7 times (range, 3 to 28) of AFP measurements: low-stable (50.0%, n = 132), sharp-falling (13.3%, n = 35), and high-rising (36.7%, n = 97). Compared with the high-rising class, HRs of disease progression were 0.52 (95% CI: 0.39, 0.70) and 0.26 (95% CI: 0.16, 0.43) for the low-stable class and sharp-falling class, respectively. In contrast, HRs of death were 0.59 (95% CI: 0.40, 0.81) and 0.30 (95% CI: 0.16, 0.57) for the two groups after propensity score adjustment. Besides, AFP trajectories had the highest relative importance of each covariate to survival.

Discussion

There are three distinct AFP trajectories in uHCC patients receiving Atez/Bev, and it is an independent biomarker for clinical outcomes.

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Fig. 1: Trajectories of serum alfa-fetoprotein and in intermediate-stage hepatocellular carcinoma patients after transarterial chemoembolization.
Fig. 2: Kaplan-Meier curves of overall survival and progression-free survival in patients with HCC after TACE treatment.
Fig. 3: The relative importance of each risk factor for overall survival and progression-free survival.

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Data availability

Qualified researchers may request access to individual patient-level data through the clinical study data request platform (https://vivli.org). Further details on Roche criteria for eligible studies are available at https://vivli.org/members/ourmembers.

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Acknowledgements

We are grateful for the support of professional knowledge form Fujian HCC-biomarker Study Group and the statistical support from Empower U team of the Department of Epidemiology and Biostatistics, X&Y solutions Inc. in Boston. This publication is based on research using data from data contributors Roche that has been made available through Vivli, Inc. Vivli has not contributed to or approved, and is not in any way responsible for, the contents of this publication.

Funding

Natural Science Foundation of Fujian Province (Nos 2020J011147); Research Initiation Foundation of Mengchao Hepatobiliary Hospital of Fujian Medical University (Nos QDZJ-2022-001).

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Author notes

  1. These authors contributed equally: Linbin Lu, Peichan Zheng, Yan Pan, Shanshan Huang.

Authors and Affiliations

  1. Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, 350025, Fuzhou, Fujian, PR China

    Linbin Lu, Xuewen Wang, Yayin Chen, Yanhong Shi & Xiong Chen

  2. Fujian Center for Safety Evaluation of New Drug, Fujian Medical University, 350122, Fuzhou, Fujian, PR China

    Peichan Zheng

  3. Department of Oncology, Fujian Provincial Hospital of Fujian Medical University, 350001, Fuzhou, Fujian, PR China

    Yan Pan

  4. Department of Oncology, the First Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, PR China

    Shanshan Huang

  5. Department of Oncology, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, 514000, Meizhou, Guangdong, PR China

    Erqian Shao

  6. Department of Oncology, Quanzhou First Hospital Affiliated to Fujian Medical University, 362002, Quanzhou, Fujian, PR China

    Yan Huang

  7. Department of Oncology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzong Clinical College of Fujian Medical University, 350025, Fuzhou, Fujian, PR China

    Gongbao Cuo, Hongyi Yang & Wangting Guo

  8. Department of Hepatobiliary Disease, Dongfang Hospital of Xiamen University Medical College, 350025, Fuzhou, Fujian, PR China

    Zhixian Wu

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Contributions

Conception and design: LLB, ZPC, TQH, HSS; Data analysis and interpretation: LLB, ZPC; Resources: LLB, ZPC, TQH, HSS; Funding acquisition: CX; Writing-original draft: LLB, ZPC; Writing-review & editing: all authors. Final approval of manuscript: all authors. LLB (doctorxiaolin@fjmu.edu.cn) is responsible for this paper.

Corresponding authors

Correspondence to Linbin Lu or Xiong Chen.

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The authors declare no competing interests.

Ethics approval and consent to participate

This is a secondary analysis based on IMbrave 150 study (ClinicalTrials.gov number, NCT03434379), and the Data Use Agreement with Research Plan is proved by the vivli platform (https://search.vivli.org/).

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Lu, L., Zheng, P., Pan, Y. et al. Trajectories of α-fetoprotein and unresectable hepatocellular carcinoma outcomes receiving atezolizumab plus bevacizumab: a secondary analysis of IMbrave150 study. Br J Cancer 129, 620–625 (2023). https://doi.org/10.1038/s41416-023-02334-7

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