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European Association for the Study of the Liver: International Liver Congress 2017 Meeting
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European Association for the Study of the Liver: International Liver Congress 2017 Meeting The dose-expansion phase of the CheckMate 040 study showed that the PD-1 immune checkpoint inhibitor nivolumab leads to durable responses in patients with advanced hepatocellular carcinoma (HCC) previously treated with sorafenib, regardless of hepatitis B or C infections. Bruno Sangro (University of Navarra, Pamplona, Spain) and colleagues gave 145 patients with sorafenibtreated HCC (30 with hepatitis C, 43 with hepatitis B, and 72 uninfected) intravenous nivolumab 3 mg/kg every 2 weeks. Objective responses (the primary endpoint) were achieved by 14·5% patients overall (20·0% with hepatitis C, 14·0% with hepatitis B, and 12·5% uninfected patients). Median duration of response was not reached, and eight of 21 responders had response lasting at least 12 months. Grade 3–4 treatment-related adverse events occurred in 16·6% of patients.
Selective internal radiotherapy in advanced HCC
The phase 3 open-label SARAH study showed no significant difference in overall survival for patients with advanced HCC treated with selective internal radiotherapy (SIRT) with yttrium-90 resin microspheres or standard-of-care sorafenib. Valerie Vilgrain (Assistance Publique Hôpitaux de Paris, Clichy, France) and colleagues randomly assigned 459 patients with locally advanced or recurrent HCC to SIRT (n=237) or oral sorafenib 800 mg daily (n=222). Median overall survival (the primary endpoint) was 8·0 months with SIRT versus 9·9 months with sorafenib (p=0·179). The cumulative incidence of radiological progression at any site did not differ between groups (p=0·255), but cumulative incidence of radiological progression in the liver as
first event was lower in the SIRT group than in the sorafenib group (p=0·015), and the proportion of patients achieving a response was higher with SIRT (p=0·042). Treatment-related serious adverse events occurred in 11·7% patients given SIRT versus 16·5% in the sorafenib group.
Rheumatoid arthritis increases HCC risk
Ching-Sheng Hsu (Tzu Chi University, Hualian, Taiwan) presented a 10-year matched cohort study showing that rheumatoid arthritis places patients at increased risk of HCC. Investi gators matched 32 603 patients with rheumatoid arthritis and 32 603 without rheumatoid arthritis from the Taiwan National Health Insurance Program. Hazard ratios (HR) were adjusted for age, sex, frequency of medical visits, and comorbidities. Overall HCC incidence was 47·4 events per 105 person-years of follow-up for people with rheumatoid arthritis versus 37·8 events per 105 personyears of follow-up for people without rheumatoid arthritis (HR 2·38 [95% CI 1·78–3·17]). Rheumatoid arthritis further increased HCC risk in patients with hepatitis B infection (HR 1·13 [95% CI 1·06–1·21]; p=0·0004); hepatitis C infection (1·26 [1·16–1·37]; p<0·0001), and liver cirrhosis (1·61 [1·46–1·78]; p<0·0001). Awareness of increased risk, the authors concluded, should help to optimise the management of both rheumatoid arthritis and HCC.
Breath test identifies HCC
2-propanol and acetone are biomarkers that could be used in breath tests to identify HCC. Ghassoub Rifai (Cleveland Clinic, OH, USA) and colleagues assessed differences in breath volatile organic compounds using selective ion flow tube mass spectrometry between cirrhotic
patients, either with HCC (n=41) or without HCC (n=24). An unadjusted analysis identified six volatile organic compounds at higher breath concentrations in patients without HCC than in those with the disease: 2-propanol, acetaldehyde, acetone, dimethyl sulphide, pentane, and trimethylamine (p<0·05 for all). 2-propanol and acetone had the highest validity for distinguishing HCC from non-HCC (p<0·001 for both).
Laparoscopic liver resection for HCC in segments 7 and 8
Laparoscopic liver resection can be done safely for HCC located in liver segments 7 or 8, according to a retrospective study. The findings contradict the belief that laparoscopic liver resection is unsuitable for these segments. 104 patients under going laparoscopic liver resection (n=46) or open liver resection (n=58) for HCC in segments 7 or 8 had similar safety outcomes for blood transfusions (p=0·526), operation times (p=0·267), post operative complications (p=0·051), and resection margins (p=0·705). Laparoscopic resection was asso ciated with less blood loss (550 mL vs 700 mL; p=0·030) and shorter hospital stays (8 days vs 10 days; p=0·001). 3-year overall survival (90·2% for laparoscopic vs 81·2% for open resection; p=0·096) and disease-free survival (15·1% vs 12·1%; p=0·857) were similar between the groups. When the laparoscopic group was subdivided into operations done before introduction of the Pringle manoeuvre, intercostal trocars, and semi-lateral patient positioning (Lap1; n=29) or afterwards (Lap2, n=17), patients in the Lap2 group had less blood loss (p=0·005) and shorter hospital stays (p=0·038).
Patrick Clenet
Nivolumab in sorafenibtreated HCC
Lancet Oncol 2017 Published Online April 27, 2017 http://dx.doi.org/10.1016/ S1470-2045(17)30317-0 The International Liver Congress 2017 was held in Amsterdam, Netherlands, on April 19–23, 2017
Janet Fricker
www.thelancet.com/oncology Published online April 27, 2017 http://dx.doi.org/10.1016/S1470-2045(17)30317-0
1
European Association for the Study of the Liver: International Liver Congress 2017 Meeting The dose-expansion phase of the CheckMate 040 study showed that the PD-1 immune checkpoint inhibitor nivolumab leads to durable responses in patients with advanced hepatocellular carcinoma (HCC) previously treated with sorafenib, regardless of hepatitis B or C infections. Bruno Sangro (University of Navarra, Pamplona, Spain) and colleagues gave 145 patients with sorafenibtreated HCC (30 with hepatitis C, 43 with hepatitis B, and 72 uninfected) intravenous nivolumab 3 mg/kg every 2 weeks. Objective responses (the primary endpoint) were achieved by 14·5% patients overall (20·0% with hepatitis C, 14·0% with hepatitis B, and 12·5% uninfected patients). Median duration of response was not reached, and eight of 21 responders had response lasting at least 12 months. Grade 3–4 treatment-related adverse events occurred in 16·6% of patients.
Selective internal radiotherapy in advanced HCC
The phase 3 open-label SARAH study showed no significant difference in overall survival for patients with advanced HCC treated with selective internal radiotherapy (SIRT) with yttrium-90 resin microspheres or standard-of-care sorafenib. Valerie Vilgrain (Assistance Publique Hôpitaux de Paris, Clichy, France) and colleagues randomly assigned 459 patients with locally advanced or recurrent HCC to SIRT (n=237) or oral sorafenib 800 mg daily (n=222). Median overall survival (the primary endpoint) was 8·0 months with SIRT versus 9·9 months with sorafenib (p=0·179). The cumulative incidence of radiological progression at any site did not differ between groups (p=0·255), but cumulative incidence of radiological progression in the liver as
first event was lower in the SIRT group than in the sorafenib group (p=0·015), and the proportion of patients achieving a response was higher with SIRT (p=0·042). Treatment-related serious adverse events occurred in 11·7% patients given SIRT versus 16·5% in the sorafenib group.
Rheumatoid arthritis increases HCC risk
Ching-Sheng Hsu (Tzu Chi University, Hualian, Taiwan) presented a 10-year matched cohort study showing that rheumatoid arthritis places patients at increased risk of HCC. Investi gators matched 32 603 patients with rheumatoid arthritis and 32 603 without rheumatoid arthritis from the Taiwan National Health Insurance Program. Hazard ratios (HR) were adjusted for age, sex, frequency of medical visits, and comorbidities. Overall HCC incidence was 47·4 events per 105 person-years of follow-up for people with rheumatoid arthritis versus 37·8 events per 105 personyears of follow-up for people without rheumatoid arthritis (HR 2·38 [95% CI 1·78–3·17]). Rheumatoid arthritis further increased HCC risk in patients with hepatitis B infection (HR 1·13 [95% CI 1·06–1·21]; p=0·0004); hepatitis C infection (1·26 [1·16–1·37]; p<0·0001), and liver cirrhosis (1·61 [1·46–1·78]; p<0·0001). Awareness of increased risk, the authors concluded, should help to optimise the management of both rheumatoid arthritis and HCC.
Breath test identifies HCC
2-propanol and acetone are biomarkers that could be used in breath tests to identify HCC. Ghassoub Rifai (Cleveland Clinic, OH, USA) and colleagues assessed differences in breath volatile organic compounds using selective ion flow tube mass spectrometry between cirrhotic
patients, either with HCC (n=41) or without HCC (n=24). An unadjusted analysis identified six volatile organic compounds at higher breath concentrations in patients without HCC than in those with the disease: 2-propanol, acetaldehyde, acetone, dimethyl sulphide, pentane, and trimethylamine (p<0·05 for all). 2-propanol and acetone had the highest validity for distinguishing HCC from non-HCC (p<0·001 for both).
Laparoscopic liver resection for HCC in segments 7 and 8
Laparoscopic liver resection can be done safely for HCC located in liver segments 7 or 8, according to a retrospective study. The findings contradict the belief that laparoscopic liver resection is unsuitable for these segments. 104 patients under going laparoscopic liver resection (n=46) or open liver resection (n=58) for HCC in segments 7 or 8 had similar safety outcomes for blood transfusions (p=0·526), operation times (p=0·267), post operative complications (p=0·051), and resection margins (p=0·705). Laparoscopic resection was asso ciated with less blood loss (550 mL vs 700 mL; p=0·030) and shorter hospital stays (8 days vs 10 days; p=0·001). 3-year overall survival (90·2% for laparoscopic vs 81·2% for open resection; p=0·096) and disease-free survival (15·1% vs 12·1%; p=0·857) were similar between the groups. When the laparoscopic group was subdivided into operations done before introduction of the Pringle manoeuvre, intercostal trocars, and semi-lateral patient positioning (Lap1; n=29) or afterwards (Lap2, n=17), patients in the Lap2 group had less blood loss (p=0·005) and shorter hospital stays (p=0·038).
Patrick Clenet
Nivolumab in sorafenibtreated HCC
Lancet Oncol 2017 Published Online April 27, 2017 http://dx.doi.org/10.1016/ S1470-2045(17)30317-0 The International Liver Congress 2017 was held in Amsterdam, Netherlands, on April 19–23, 2017
Janet Fricker
www.thelancet.com/oncology Published online April 27, 2017 http://dx.doi.org/10.1016/S1470-2045(17)30317-0
1