Interaction between baseline HBV loads and the prognosis of patients
with HCC who receive anti-PD-1 in combination with an antiangiogenic
therapy and are simultaneously given TAF prophylaxis
Abstract
Aims: A high baseline hepatitis B virus (HBV) load has always been
listed as an exclusion criterion for programmed cell death-1 (PD-1)
inhibitor-associated therapy in clinical trials, as the interaction
between HBV load and anti-PD-1/PD-L1 therapy remains controversial.
Methods: We performed a retrospective cohort study of unresectable HCC
patients who were seropositive for HBsAg and accepted tenofovir
alafenamide fumarate (TAF) therapy before anti-PD-1 in combination with
an antiangiogenic treatment. Patients were divided into a low HBV DNA
group (≤ 2000 IU/ml) and a high HBV DNA group (> 2000
IU/ml) according to the baseline HBV DNA levels. Tumour response and
progression-free survival (PFS) were compared, and univariate and
multivariate Cox analyses were performed to identify potential risk
factors for PFS. The incidences of HBV reactivation and HBV-associated
hepatitis were also recorded. Results: Seventy eligible patients were
included: 48 in the low group and 22 in the high group. The objective
response rates (ORRs), disease control rates (DCRs), and PFS did not
differ significantly between the two groups (P = 0.761, 0.552, and
0.784, respectively). The results of Cox analyses revealed that the
baseline HBV load did not affect PFS. Additionally, HBV reactivation
occurred in only 2 patients (2.9%), and no patient experienced
HBV-related hepatic impairment when given a continuous TAF treatment.
Conclusions: Baseline HBV loads do not affect the prognosis of HCC
patients receiving anti-PD-1 in combination with an antiangiogenic
therapy, while PD-1 inhibitors do not aggravate HBV reactivation and
hepatic impairment in patients simultaneously subjected to TAF
prophylaxis.