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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1508028
This article is part of the Research Topic Hepatocellular Carcinoma: Novel Treatment Strategies - Volume III View all 15 articles

Prognostic Significance of Early Alpha Fetoprotein and Des-Gamma-Carboxy Prothrombin Responses in Unresectable Hepatocellular Carcinoma Patients Undergoing Triple Combination Therapy

Provisionally accepted
Teng Zhang Teng Zhang 1,2,3Wengang Li Wengang Li 1Qian Chen Qian Chen 1Weiping He Weiping He 1Jing Sun Jing Sun 1Dong Li Dong Li 1Quan Wang Quan Wang 1*Xuezhang Duan Xuezhang Duan 1,3*
  • 1 Fifth Medical Center of the PLA General Hospital, Beijing, China
  • 2 The 983 Hospital of the Joint Logistics Support Force, Chinese People's Liberation Army, Tianjin, China
  • 3 People's Liberation Army General Hospital, Beijing, China

The final, formatted version of the article will be published soon.

    Background: Recent advancements in combination therapy for unresectable hepatocellular carcinoma (uHCC) have shown promise, but reliable serological prognostic indicators are currently lacking for patients undergoing triple combination therapy of stereotactic body radiation therapy (SBRT), immunotherapy, and targeted therapy. We aimed to investigate the prognostic significance of early alpha fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) responses in these patients.Methods: This retrospective research included 115 uHCC patients treated with SBRT in combination with immunotherapy and targeted therapy (triple therapy) at our institution from April 2021 to December 2022. Participants were categorized into high AFP and high DCP cohorts based on baseline levels. AFP and DCP responses were defined as decreases from baseline of over 50% and 70%, respectively, according to ROC curve analysis. Differences in overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) were assessed between the tumor biomarker response and non-response groups.Results: Multivariate analysis indicated that AFP or DCP response at 6-8 weeks post-therapy significantly influenced ORR (high AFP cohort: odds ratio [OR] 5.50, 95% CI 2. p=0.001; high DCP cohort: OR 7.99, p＜0.001 ). The median PFS was notably longer in tumor biomarker response groups (high AFP cohort: 13.7 vs 6.2 months, hazard ratio [HR] 0.36, 95% CI 0.20-0.62, p<0.001; high DCP cohort: 15.6 vs 9.3 months, HR 0.44, 95% CI 0.26-0.74, p=0.002). AFP or DCP response was associated with prolonged OS (high AFP cohort: not reached vs. 21.9 months, HR 0.47, 95% CI 0.22-0.99, p=0.047; high DCP cohort: not reached vs. 20.6 months, HR 0.35, 95% CI 0.14-0.86, p=0.022). Conclusion: AFP or DCP response at 6-8 weeks post-therapy predicts better oncological outcomes in patients with uHCC treated with triple therapy.

    Keywords: hepatocellular carcinoma1, triple combination therapy2, stereotactic body radiation therapy (SBRT) 3, alpha fetoprotein (AFP)4, des-gamma-carboxy prothrombin (DCP)5

    Received: 08 Oct 2024; Accepted: 28 Nov 2024.

    Copyright: © 2024 Zhang, Li, Chen, He, Sun, Li, Wang and Duan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Quan Wang, Fifth Medical Center of the PLA General Hospital, Beijing, China
    Xuezhang Duan, Fifth Medical Center of the PLA General Hospital, Beijing, China

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