Hyperprogressive disease during PD-1 blockade in patients with advanced hepatocellular carcinoma

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dc.contributor.authorKim, Chang Gonko
dc.contributor.authorKim, Chanko
dc.contributor.authorYoon, Sang Eunko
dc.contributor.authorKim, Kyung Hwanko
dc.contributor.authorChoi, Seong Jinko
dc.contributor.authorKang, Beodeulko
dc.contributor.authorKim, Hye Ryunko
dc.contributor.authorPark, Su-Hyungko
dc.contributor.authorShin, Eui-Cheolko
dc.contributor.authorKim, Yeun-Yoonko
dc.contributor.authorKim, Dae Jungko
dc.contributor.authorChung, Hyun Cheolko
dc.contributor.authorChon, Hong Jaeko
dc.contributor.authorChoi, Hye Jinko
dc.contributor.authorLim, Ho Yeongko
dc.date.accessioned2021-03-17T06:50:21Z-
dc.date.available2021-03-17T06:50:21Z-
dc.date.created2021-03-17-
dc.date.issued2021-02-
dc.identifier.citationJOURNAL OF HEPATOLOGY, v.74, no.2-
dc.identifier.issn0168-8278-
dc.identifier.urihttp://hdl.handle.net/10203/281630-
dc.description.abstractBackground & Aims: Programmed cell death-1 (PD-1) inhibitor treatment can cause hyperprogressive disease (HPD), but the incidence, outcome, and predictive factors of HPD are unknown in patients with hepatocellular carcinoma (HCC). Herein, we assessed the existence and factors predictive of HPD in patients with advanced HCC treated with nivolumab. Methods: We enrolled 189 patients with advanced HCC treated with nivolumab. Occurrence of HPD was investigated using tumour growth dynamics based on tumour growth kinetics (TGK) and tumour growth rate (TGR) before and after treatment, or time to treatment failure. We additionally analysed patients treated with regorafenib (n = 95) or best supportive care (BSC)/ placebo (n = 103) after progression on sorafenib to compare tumour growth dynamics. Results: Flare-up of tumour growth was observed in a fraction of patients upon PD-1 blockade, indicating the occurrence of HPD. Based on distinct patterns of disease progression exclusively observed in the nivolumab-treated cohort, but not in the regorafenib- or BSC/placebo-treated cohorts, 4-fold increases in TGK and TGR ratios as well as a 40% increase in TGR were the cut-off values used to define HPD; 12.7% of the patients (24/189) treated with nivolumab met all these criteria. Patients with HPD had worse progression-free survival (hazard ratio [HR] 2.194; 95% CI 1.214-3.964) and overall survival (HR 2.238; 95% CI 1.233-4.062) compared to patients with progressive disease without HPD. More than 90% of patients with HPD missed the opportunity for subsequent treatment because of rapid clinical deterioration. An elevated neutrophil-to-lymphocyte ratio (>4.125) was associated with HPD and an inferior survival rate. Conclusions: HPD occurs in a fraction of patients with HCC who receive PD-1 inhibitor treatment. Analyses of the baseline immune profile and on-treatment tumour growth dynamics could enable optimal patient selection and earlier identification of HPD. Lay summary: Hyperprogressive disease is an unexpected response pattern observed in patients treated with an immune checkpoint inhibitor. This study revealed that hyperprogressive disease occurs in a fraction of patients with advanced hepatocellular carcinoma treated with an anti-PD-1 antibody, providing evidence to encourage careful monitoring of patients to prevent clinical deterioration induced by PD-1 blockade. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.-
dc.languageEnglish-
dc.publisherELSEVIER-
dc.titleHyperprogressive disease during PD-1 blockade in patients with advanced hepatocellular carcinoma-
dc.typeArticle-
dc.identifier.wosid000612194700012-
dc.identifier.scopusid2-s2.0-85094596099-
dc.type.rimsART-
dc.citation.volume74-
dc.citation.issue2-
dc.citation.publicationnameJOURNAL OF HEPATOLOGY-
dc.identifier.doi10.1016/j.jhep.2020.08.010-
dc.contributor.localauthorPark, Su-Hyung-
dc.contributor.localauthorShin, Eui-Cheol-
dc.contributor.nonIdAuthorKim, Chang Gon-
dc.contributor.nonIdAuthorKim, Chan-
dc.contributor.nonIdAuthorYoon, Sang Eun-
dc.contributor.nonIdAuthorChoi, Seong Jin-
dc.contributor.nonIdAuthorKang, Beodeul-
dc.contributor.nonIdAuthorKim, Hye Ryun-
dc.contributor.nonIdAuthorKim, Yeun-Yoon-
dc.contributor.nonIdAuthorKim, Dae Jung-
dc.contributor.nonIdAuthorChung, Hyun Cheol-
dc.contributor.nonIdAuthorChon, Hong Jae-
dc.contributor.nonIdAuthorChoi, Hye Jin-
dc.contributor.nonIdAuthorLim, Ho Yeong-
dc.description.isOpenAccessN-
dc.type.journalArticleArticle-
dc.subject.keywordAuthorHepatocellular carcinoma-
dc.subject.keywordAuthorPD-1 blockade-
dc.subject.keywordAuthorTumour growth dynamics-
dc.subject.keywordAuthorHyperprogressive disease-
dc.subject.keywordAuthorNeutrophil-to-lymphocyte ratio-
dc.subject.keywordPlusATEZOLIZUMAB PLUS BEVACIZUMAB-
dc.subject.keywordPlusIMMUNE CHECKPOINT BLOCKADE-
dc.subject.keywordPlusPROGNOSTIC SCORE-
dc.subject.keywordPlusPROSPECTIVE VALIDATION-
dc.subject.keywordPlusSUPPRESSOR-CELLS-
dc.subject.keywordPlusOPEN-LABEL-
dc.subject.keywordPlusPEMBROLIZUMAB-
dc.subject.keywordPlusTHERAPY-
dc.subject.keywordPlusTRIALS-
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