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Take a look at a selection of our recent media coverage:

Atezolizumab anti-drug antibodies worsen survival in hepatocellular carcinoma

28th October 2022

Atezolizumab anti-drug antibodies are associated with a both a worse progression-free and overall survival in hepatocellular carcinoma

The development of atezolizumab anti-drug antibodies in patients with hepatocellular carcinoma results in both a worse progression-free and overall survival according to the findings of a prospective cohort study by Korean researchers.

Hepatocellular carcinoma (HCC) is the most common form of liver cancer and globally, in 2020 there were an estimated 900,000 new cases and a similar number (830,180) of deaths. Early stages of the disease can are curable by resection, liver transplantation, or ablation although more than 80% of patients with HCC present for treatment at an unresectable stage and research suggests that in patients with unresectable hepatocellular carcinoma, atezolizumab combined with bevacizumab has proven to be an effective therapy. Nevertheless, a recognised problem with immune checkpoint inhibitors, is the development of anti-drug antibodies (ADAs) which can cause a decrease in the amount of drug available, resulting in some cases in decreased anti-tumour activity and a consequent impact on clinical outcomes. According to an analysis of data from ≈ 4500 patients from 12 clinical trials across different tumour types, treatment settings, and dosing regimens, atezolizumab anti-drug antibodies developed in approximately 30% of patients although this ranged from 13-54%. Fortunately, however, the authors also reported that ADAs only increased atezolizumab clearance by 9%. Nevertheless, much less is known about the impact of atezolizumab anti-drug antibodies outside of the clinical trial setting. As a result, in the present study, the Korean researchers examined the clinical and immunological association of highly elevated ADAs, 3 weeks after starting atezolizumab and bevacizumab therapy in patients treated for advanced HCC.

The researchers conducted their study in two phases: an initial discovery cohort who were treated at a single centre and a validation cohort from 4 other centres. Patients were all at least 20 years of age with locally advanced or unresectable HCC and who had received no prior therapy. Blood samples were collected before the first administration of atezolizumab and which served as a baseline measurement and then again before the second dose (C2D1), three weeks later. The researchers assessed the atezolizumab ADA positivity rate and treatment outcomes.

Atezolizumab anti-drug antibodies and treatment outcomes

A total of 132 patients with a median age of 61 years (84.1% male) were included with 50 in the discovery and 82 the validation cohort. The median follow-up time was 19.4 and 13.4 months in the discovery and validation cohorts respectively.

When compared to baseline levels, atezolizumab ADAs were elevated at C2D1 (median values 45.95 vs 0 ng/ml, p < 0.001). Not all patients developed ADAs although this developed to a greater extent in those with progressive disease.

When the researchers examined the clinical outcomes according to ADA status at C2D1, those with the highest atezolizumab ADAs had a lower response. For example, those with high ADA levels at C2D1 in the validation cohort, had a worse progression-free survival (hazard ratio, HR = 2.52, 95% CI 1.27 – 5.01, p = 0.006) and a worse overall survival (HR = 5.81, 95% CI 2.70 – 12.50, p = 0.001) compared to patients with low ADA levels. In fact, those with higher ADAs had a reduced serum atezolizumab levels as well as other impaired markers e.g., CD8-positive T-cell proliferation.

The authors concluded that highly elevated atezolizumab ADAs may be associated with poor clinical outcomes in patients with advanced HCC by reducing atezolizumab exposure and an attenuated anti-cancer drug efficacy.

Kim C et al. Association of High Levels of Antidrug Antibodies Against Atezolizumab With Clinical Outcomes and T-Cell Responses in Patients With Hepatocellular Carcinoma JAMA Oncol 2022

Racial disparities identified in access to immunotherapy for advanced HCC

8th August 2022

A study has identified clear racial disparities with access to immunotherapy among patients with advanced hepatocellular carcinoma in the US

Racial disparities in access to immunotherapy as a first-line option for advanced hepatocellular carcinoma (HCC) have been revealed in a retrospective analysis of the US National Cancer Database by US researchers.

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and data for 2018 indicate that globally, there were an estimated 661,000 cases. Moreover, in recent years, treatment for HCC has been revolutionised by the introduction of checkpoint inhibitors and data has shown how the combination of the anti-PDL1 antibody atezolizumab and the anti-VEGF antibody bevacizumab was superior to sorafenib in a phase 3, randomised controlled trial.

Whilst such treatments have proven to be effective, a problem for the wider generalisability of these findings is that in major cancer trials, there is under enrolment of racial and ethnic minorities.

For the present study, the US team sought to explore the demographic breakdown of immunotherapy for advanced HCC to examine if there was any evidence of racial disparity in the uptake of therapy.

Turning to the National Cancer Database, the team retrospectively looked at patients with tumour node metastasis stage 3 or 4 HCC between 2017 and 2018 and who underwent either chemotherapy or immunotherapy. They also collected a range of additional information such as co-morbidities, demographics and specific clinical parameters e.g., tumour size, alpha-fetoprotein category etc as well as socioeconomic status, insurance status and reported levels of income and educational achievement.

Racial disparities and immunotherapy

A total of 3990 patients with a mean age of 64.2 (81.3% male) were included in the analysis of whom, 81.4% received chemotherapy.

Among those treated with immunotherapy, there was a much higher proportion of White individuals (66.6%) compared to Hispanic (9.1%) or Black (14%).

Using multivariable regression, use of immunotherapy was independently associated with improved overall survival (adjusted hazard ratio, aHR = 0.76, 95% CI 0.65 – 0.88) compared to chemotherapy and there was no evidence of racial disparities with respect to overall survival.

However, when the researchers considered the factors associated with use of immunotherapy as a first-line treatment for advanced HCC, Black patients were significantly less likely to receive immunotherapy compared to White patients (odds ratio, OR = 0.71, 95% CI 0.54 – 9.89, p = 0.006) as were Hispanics (OR = 0.63, 95% CI 0.46 – 0.83, p = 0.002). Despite this there was no evidence that first-line use of immunotherapy was influenced by socioeconomic or educational factors.

The authors concluded that a comprehensive approach is urgently required to both monitor and eliminate racial disparities observed in the management of advanced HCC.

Ahn JC et al. Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States Hepatology 2022