Immunotherapies Safer than Tyrosine Kinase Inhibitors in Liver Cancer
According to a new study, for advanced hepatocellular carcinoma (liver cancer), when used as neoadjuvant therapy (shrinking treatment before the main treatment), immunotherapies may, compared with the standard liver cancer treatment, tyrosine kinase inhibitors, be “more suitable”.
JAMA Network Open published a meta-analysis suggesting that immune checkpoint inhibitor immunotherapies may be safer as neoadjuvant treatment for patients with advanced hepatocellular carcinoma (HCC) than tyrosine kinase inhibitors (TKIs), known as targeted cancer drugs.
The researchers found lower rates of serious adverse effects with immunotherapies than with TKIs. However, liver toxicity rates were similar with the 2 types of treatment.
The researchers conducted this meta-analysis to assess existing evidence on the adverse-effect profiles of treatments for advanced liver cancer, with a particular focus on designing clinical trials for neoadjuvant therapy.
The analysis included data from 30 single-arm, placebo-controlled and dual-agent phase 2 and 3 clinical trials. The trials covered 12,921 patients with advanced liver cancer.
The researchers found serious adverse effects in 46% of patients receiving TKIs, 24% receiving immunotherapy and 36% receiving immunotherapy plus a TKI.
How Is a Treatment Adverse Effect Graded?
- Grade 0: Toxicity (adverse effect) absent
- Grade 1: Mild adverse effect
- Grade 2: Moderate adverse effect; medical intervention required
- Grade 3: Severe adverse effect; hospitalisation required
- Grade 4: Life-threatening adverse effect
- Grade 5: Death
Liver-related adverse effects were observed in 21% of patients receiving TKIs and 28% receiving immunotherapy.
The researchers also compared sorafenib, the TKI most frequently preferred in liver cancer, with other TKIs and found a similar risk of liver-related adverse effects between the groups (risk ratio [RR], 1.06; 95% CI, 0.92-1.24).
When the researchers compared immunotherapies with sorafenib, they found similar risks of liver-related and other adverse effects.
In conclusion, in this study immunotherapies had a more favourable adverse-effect profile than TKIs in patients with advanced liver cancer and may therefore be more suitable drugs for neoadjuvant therapy.
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