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CIRO CELSA

Safety and Preliminary Efficacy of Pembrolizumab Following Transarterial Chemoembolization for Hepatocellular Carcinoma: The PETAL Phase Ib Study

  • Authors: Pinato, David J.; D'Alessio, Antonio; Fulgenzi, Claudia Angela Maria; Schlaak, Alexandra Emilia; Celsa, Ciro; Killmer, Saskia; Blanco, Jesus Miguens; Ward, Caroline; Stikas, Charalampos-Vlasios; Openshaw, Mark R.; Acuti, Nicole; Nteliopoulos, Georgios; Balcells, Cristina; Keun, Hector C.; Goldin, Robert D.; Ross, Paul J.; Cortellini, Alessio; Thomas, Robert; Young, Anna-Mary; Danckert, Nathan; Tait, Paul; Marchesi, Julian R.; Bengsch, Bertram; Sharma, Rohini
  • Publication year: 2024
  • Type: Articolo in rivista
  • OA Link: http://hdl.handle.net/10447/664696

Abstract

Purpose: Transarterial chemoembolization (TACE) may prime adaptive immunity and enhance immunotherapy efficacy. PETAL evaluated safety, preliminary activity of TACE plus pembrolizumab and explored mechanisms of efficacy. Patients and methods: Patients with liver-confined hepatocellular carcinoma (HCC) were planned to receive up to two rounds of TACE followed by pembrolizumab 200 mg every 21 days commencing 30 days post-TACE until disease progression or unacceptable toxicity for up to 1 year. Primary endpoint was safety, with assessment window of 21 days from pembrolizumab initiation. Secondary endpoints included progression-free survival (PFS) and evaluation of tumor and host determinants of response. Results: Fifteen patients were included in the safety and efficacy population: 73% had nonviral cirrhosis; median age was 72 years. Child-Pugh class was A in 14 patients. Median tumor size was 4 cm. Ten patients (67%) received pembrolizumab after one TACE; 5 patients after two (33%). Pembrolizumab yielded no synergistic toxicity nor dose-limiting toxicities post-TACE. Treatment-related adverse events occurred in 93% of patients, most commonly skin rash (40%), fatigue, and diarrhea (27%). After a median follow-up of 38.5 months, objective response rate 12 weeks post-TACE was 53%. PFS rate at 12 weeks was 93% and median PFS was 8.95 months [95% confidence interval (CI): 7.30-NE (not estimable)]. Median duration of response was 7.3 months (95% CI: 6.3-8.3). Median overall survival was 33.5 months (95% CI: 11.6-NE). Dynamic changes in peripheral T-cell subsets, circulating tumor DNA, serum metabolites, and in stool bacterial profiles highlight potential mechanisms of action of multimodal therapy. Conclusions: TACE plus pembrolizumab was tolerable with no evidence of synergistic toxicity, encouraging further clinical development of immunotherapy alongside TACE.