The CRAFITY score: A promising prognostic predictor for patients with hepatocellular carcinoma treated with tyrosine kinase inhibitor and immunotherapy combinations

Yang, Yi; Ouyang, Jingzhong; Zhou, Yanzhao; Zhou, Jinxue; Zhao, Hong

doi:10.1016/j.jhep.2022.03.018

Cited by 22 publications

(17 citation statements)

References 7 publications

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“…In our patient population treated with atezo/bev, we can confirm the ability of the CRAFITY score to identify patients with poor treatment benefit. Our cohort was retrospective with limited sample size, however, our findings are similar to those of two cohorts of Chinese HCC patients, one treated with the tyrosine kinase inhibitor lenvatinib as monotherapy and the other cohort treated with the combination of lenvatinib plus immunotherapy that were recently published in response to the original publication (6). The accuracy of our observation needs confirmation, as does the question of whether different treatment regimens (e.g., including VEGF inhibitors) require adjusted use of the CRAFITY score.…”

supporting

confidence: 74%

The CRAFITY score can identify patients with hepatocellular carcinoma showing poor response to treatment with atezolizumab and bevacizumab

Lieb¹,

Ebel²,

Seehofer³

et al. 2023

Hepatobiliary Surg Nutr

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supporting

confidence: 74%

The CRAFITY score can identify patients with hepatocellular carcinoma showing poor response to treatment with atezolizumab and bevacizumab

Lieb¹,

Ebel²,

Seehofer³

et al. 2023

Hepatobiliary Surg Nutr

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“…The patients with HCC who were admitted to the Department of Oncology mostly had an advanced cancer, and they were often complicated with cirrhosis, liver insufficiency, hypoproteinemia, ascites, and abnormal anticoagulant function, resulting in a poorer Child‐Pugh grade. In the real world, patients with a poorer Child‐Pugh grade (e.g., B) could still receive immunotherapy under meticulous care 24–28 . 33.3% of the patients had a history of hepatitis B infection, 8.3% had positive HBV‐DNA, and 12.5% had cirrhosis.…”

Section: Resultsmentioning

confidence: 99%

Associations of circulating immunomarkers with the efficacy of immunotherapy for primary hepatic carcinoma

Liu,

Xu,

Shu

et al. 2023

Cancer Medicine

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BackgroundPeripheral blood immunomarkers are associated with prognosis in patients with solid tumors receiving chemotherapy or immunotherapy. In this study, the associations of circulating neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR), and platelet‐to‐lymphocyte ratio (PLR), as well as their dynamic changes were investigated in relation to the efficacy of immunotherapy in patients with primary liver cancer.MethodsComparisons were made between NLR, MLR, and PLR among individuals exhibiting disease control (defined as the best response of partial response [PR] or stable disease [SD]) and those with progressive disease (PD). Additionally, disease control rate (DCR), overall survival (OS), and progression‐free survival (PFS) were compared between individuals with different NLR, MLR, and PLR levels before initiating palliative immunotherapy. Furthermore, comparisons were made between patients with different alterations in the ratios at the second cycle of immunotherapy compared to baseline. These analyses were performed using univariate and multivariate approaches. A total of 119 Chinese patients with liver cancer who underwent immunotherapy were included in this study, which focused on hepatocellular carcinoma (HCC).ResultsIn cases with HCC (n = 104), the cutoffs of NLR, MLR, and PLR to differentiate treatment responders from nonresponders were 3.38, 0.28, and 227.18, respectively. Patients with the best response of PR or SD had significantly lower NLR and MLR. Patients with NLR <3.38 and those with MLR <0.28 significantly had longer OS and PFS than their counterparts, and those with PLR <227.18 had significantly longer PFS, both in overall patients and in various patient subgroups. Lower NLR, MLR, or PLR was associated with earlier BCLC stage, fewer metastatic sites, less frequent extrahepatic metastasis, or better performance status. For individuals who had an unfavorable baseline NLR ≥3.38, MLR ≥0.28, or a favorable baseline PLR <227.18 prior to first immunotherapy, a decrease in NLR, MLR, or PLR at Cycle 2 of immunotherapy was significantly associated with a higher DCR.ConclusionsAmong patients with HCC who received immunotherapy, lower NLR, and MLR at baseline in overall patients were significantly associated with better disease control and more favorable survival outcomes (both OS and PFS), and lower PLR was significantly associated with longer PFS. The findings of this research may offer useful hints foranoptimized selection of patients with liver cancer who may benefit more from immunotherapy.

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“…Baseline PLR and SIRI are also associated with the prognosis for HCC ( 9 , 25 , 26 ). In addition, the combination of C-reactive protein (CRP) and AFP showed a prognostic role in HCC patients receiving tyrosine kinase inhibitors (TKIs) combined with immunotherapy ( 27 , 28 ). However, CRP is not a mandatory test for every patient in our hospital, hence its limited application in current clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and prognostic factors in initially unresectable hepatocellular carcinoma treated using conversion therapy with lenvatinib and TACE plus PD-1 inhibitors

Chen

Wang

et al. 2023

Front. Oncol.

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PurposeTo evaluate the outcomes and prognostic factors for patients using conversion therapy with lenvatinib combined with transcatheter arterial chemoembolization (TACE) plus programmed cell death protein-1 (PD-1) inhibitors (LTP) for initially unresectable hepatocellular carcinoma (iuHCC).MethodsData on 94 consecutive patients with iuHCC who received LTP conversion therapy from November 2019 to September 2022 were retrospectively analyzed. Early tumor response was reported when patients showed complete or partial response at the time of their first follow-up (4–6 weeks) after initial treatment, in accordance with mRECIST. The endpoints consisted of conversion surgery rate, overall survival (OS), and progression-free survival (PFS).ResultsEarly tumor response was found in 68 patients (72.3%) and not in the remaining 26 patients (27.7%) in the entire cohort. Early responders had a significantly higher conversion surgery rate than non-early responders (44.1% vs. 7.7%, p=0.001). Early tumor response was the only factor independently associated with successful conversion resection, as indicated by multivariate analysis (OR=10.296; 95% CI: 2.076–51.063; p=0.004). Survival analysis showed that early responders had longer PFS (15.4 vs. 7.8 months, p=0.005) and OS (23.1 vs. 12.5 months, p=0.004) than non-early responders. Early responders who underwent conversion surgery also had significantly longer median PFS and OS (not reached, not reached) than those who did not (11.2 months, p=0.004; 19.4 months, p<0.001). In multivariate analyses, early tumor response was identified as an independent prognostic factor for longer OS (HR=0.404, 95% CI: 0.171–0.954; p=0.039). Successful conversion surgery was also an independent predictive factor for longer PFS (HR=0.248, 95% CI: 0.099–0.622; p=0.003) and OS (HR=0.147, 95% CI: 0.039–0.554; p=0.005).ConclusionsEarly tumor response is an important predictive marker for successful conversion surgery and prolonged survival in patients with iuHCC treated using LTP conversion therapy. Conversion surgery is necessary to improve survival during conversion therapy, particularly for early responders.

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The CRAFITY score: A promising prognostic predictor for patients with hepatocellular carcinoma treated with tyrosine kinase inhibitor and immunotherapy combinations

Cited by 22 publications

References 7 publications

The CRAFITY score can identify patients with hepatocellular carcinoma showing poor response to treatment with atezolizumab and bevacizumab

The CRAFITY score can identify patients with hepatocellular carcinoma showing poor response to treatment with atezolizumab and bevacizumab

Associations of circulating immunomarkers with the efficacy of immunotherapy for primary hepatic carcinoma

Outcomes and prognostic factors in initially unresectable hepatocellular carcinoma treated using conversion therapy with lenvatinib and TACE plus PD-1 inhibitors

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