Z Gastroenterol 2021; 59(08): e325
DOI: 10.1055/s-0041-1734228
VORTRÄGE

Predicting the outcome of patients with hepatocellular carcinoma treated with immunotherapy - the CRAFITY score

B Scheiner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
K Pomej
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
MM Kirstein
2   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
F Hucke
3   Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
,
F Finkelmeier
4   Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
,
O Waidmann
5   Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Austria
,
K Schulze
6   1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
,
S Koch
7   Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
,
S Spahn
8   Department Internal Medicine I, Eberhard-Karls University, Tübingen, Germany
,
P Radu
9   Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland
,
AR Siebenhüner
10   Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Zürich, Switzerland
,
JC Mertens
11   Department of Hepatology and Gastroenterology, University Hospital Zurich and University Zurich, Zürich, Switzerland
,
NN Rahbari
12   Department of Surgery at University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
F Kütting
13   Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
,
D Waldschmidt
13   Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
,
MP Ebert
14   Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
A Teufel
14   Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
SDe Dossa
15   Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Lugano, Switzerland
,
DJ Pinato
16   Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
,
T Meischl
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
L Balcar
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
C Müller
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
T Reiberger
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
M Pinter
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
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Background Immunotherapy with atezolizumab plus bevacizumab represents the new standard of care in systemic front-line treatment of hepatocellular carcinoma (HCC). Biomarkers to predict treatment success are an unmet need.

Methods Patients with HCC treated with PD-(L)1-based immunotherapy between July 2015 and May 2020 in 6 European centers (training set; n = 104) and between August 2015 and February 2020 in 7 European centers (validation set; n = 73) were included. We investigated the prognostic value of baseline variables by using a Cox regression model in the training set and developed the CRAFITY (CRP and AFP in ImmunoTherapY) score. The score was validated in the independent, external cohort.

Results Baseline serum alpha-fetoprotein (AFP) ≥200 ng/ml (HR, 2.0; p = 0.009) and C-reactive protein (CRP) ≥1 mg/dl (HR, 2.0; p < = 0.016) were identified as independent negative prognostic factors in multivariable analysis and were used to develop the CRAFITY score. Patients who fulfilled none or only one criterion (0-1 point; CRAFITY-low) had a significantly longer median overall survival (21.8 (95 %CI, 13.4-30.2) months) than patients meeting both criteria (2 points; CRAFITY-high; 5.3 (95 %CI, 1.9-8.6) months; p < 0.001). Additionally, they had a significantly better disease control rate (70 % vs. 32 %; p = 0.001). These results were confirmed in the independent validation set and remained significant irrespective of Child-Pugh stage and treatment line.

Conclusions The CRAFITY score identifies patients with favorable disease control and survival. The score may help to guide treatment decisions and patient counseling.



Publication History

Article published online:
01 September 2021

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