Chief Physician The First Affiliated Hospital of Soochow University, China (People's Republic)
Purpose: This retrospective study evaluated the albumin-bilirubin (ALBI) score, an objective measure of liver function, in patients with advanced hepatocellular carcinoma (HCC) who received immune checkpoint inhibitors (ICIs) plus anti-vascular endothelial growth factor (anti-VEGF) antibody/tyrosine kinase inhibitors (TKIs) with or without transarterial chemoembolization (TACE) as first-line treatment.
Materials and Methods: Patients with Barcelona Clinic Liver Cancer (BCLC) stage C HCC who received either TACE with ICIs plus anti-VEGF antibody/TKIs (TACE-ICI-TKI) or only ICIs plus anti-VEGF antibody/TKIs (ICI-TKI) as first-line treatment from January 2018 to June 2023 were retrospectively included. Liver function indicators were collected when both albumin and bilirubin results were available prior to treatment initiation and when either albumin or bilirubin results were available on the specified day. The study compared the time to ALBI grade increase and the change in ALBI score from baseline to the end of treatment between the two groups to analyze whether the TACE-ICI-TKI treatment regimen exacerbates liver function deterioration compared to systemic therapies alone.
Results: Among 78 patients included in the analysis, 36 (46.2%) patients received TACE-ICI-TKI treatment, and 42 (53.8%) patients received ICI-TKI treatment. at baseline, 19 patients had an ALBI grade 1 score (TACE-ICI-TKI, n=9; ICI-TKI, n=10) and 58 had an ALBI grade 2 score (n=27; n=31). A total of 34 (43.6%) patients experienced an ALBI grade increase during the follow-up period. The Time to ALBI grade increase was similar in both arms [median for TACE-ICI-TKI versus ICI- TKI: 3.5 versus 2.0 months; hazard ratio (HR)=0.96 (95% CI: 0.47–1.94), P=0.900]. The change from baseline in ALBI score to the end of treatment was also similar in both arms [difference in least squares mean, −0.056; 95% confidence interval (CI): -0.325 to 0.212, P=0.678]. A trend toward improved overall survival (OS) was observed with TACE-ICI-TKI group [18.3 months (95% CI: 10.6–26.0) vs. 8.8 months (4.2–13.4); P=0.002; HR 0.43 (95% CI: 0.25–0.74)]. Median PFS was also longer in TACE-ICI-VEGF group [10.9 months (7.2–14.6) vs. 8.5 months (3.3–13.6); HR 0.73 (0.41–1.28)] according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), but there was no statistical difference.
Conclusion: TACE combined with systemic therapies did not adversely impact liver function compared to systemic therapies alone in advanced HCC patients, as measured by changes in ALBI scores.
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