CRP, AFP score identifies disease control, survival in HCC

The C-reactive protein and alpha-fetoprotein in immunotherapy score identified patients with favorable hepatocellular carcinoma disease control and survival, according to a study presented at the International Liver Congress.

“The combination treatment of atezolizumab and bevacizumab is the new reference standard in systemic first-line treatment for patients with advanced HCC; further, promising results from other immunotherapy-based regimens in patients with HCC have recently been reported,” Bernhard Scheiner, MD, Medical University of Vienna, said. “While one-third of patients respond to treatment with immunotherapy, two-thirds of patients do not show an objective response to immunotherapy-based regimens. Biomarkers to guide treatment decisions in HCC patients undergoing immunotherapy are an unmet need.”

In a retrospective, multicenter study, researchers aimed to develop a single prognostic and value based on routine laboratory parameters to predict disease outcomes. They assessed 104 patients with HCC (median age 66 years; 79% men) using a Cox regression model and developed the C-reactive protein and alpha-fetoprotein in immunotherapy (CRAFITY) score; an independent cohort of 73 patients with HCC (median age 64.4 years; 81% men) validated CRAFITY scores. Independent negative prognostic factors were identified as baseline AFP 200 ng/mL (HR = 2; criteria 1) and baseline CRP 1 mg/dL (HR = 2; criteria 2). Researchers labeled patients who met both criteria as CRAFITY-high and patients who met zero or one criterion as CRAFITY-low.

Compared with patients labeled CRAFITY-high, patients labeled CRAFITY-low had longer median overall survival (21.8 months; 95% CI, 13.4-30.2 vs. 5.3 months; 95% CI, 1.9-8.6) and had a better rate of disease control (70% vs. 32%). The validation cohort confirmed these results for median overall survival (14.2 months; 95% CI, 9.7-18.7 vs. 8.6 months; 95% CI, 6.1-11.3) and disease control (75% vs. 41%).

“We developed a simple lab based or based on the two lab parameters CRP and AFP that predicted the likelihood of immunotherapy success and improved survival in HCC patients. Importantly, these results were confirmed in an independent external validation cohort,” Scheiner concluded. “There's biological rationale for combining these two parameters as CRP suppresses the function of activated CD4+ and CD8+ T-cells and AFP may influence anti-tumor immunity. Of course, the CRAFITY score needs a prospective validation.”