The Impact of Infections in Patients Treated with Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Data Collection
2.3. Statistical Analysis and Outcomes
3. Results
3.1. Baseline Factors
3.2. Infections
3.3. Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Conflicts of Interest
References
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Total | No Infection | Infection | p-Value | |
---|---|---|---|---|
N = 34 | N = 17 | N = 17 | ||
Age | 66.29 ± 9.39 | 68.43 ± 10.47 | 64.15 ± 7.89 | 0.19 |
Sex | 0.66 | |||
Male | 28 (82.35) | 13 (76.47) | 15 (88.24) | |
Female | 6 (17.65) | 4 (23.53) | 2 (11.76) | |
Race | 0.69 | |||
White | 26 (76.47) | 12 (70.59) | 14 (82.35) | |
Other | 8 (23.53) | 5 (29.41) | 3 (17.65) | |
Comorbidities | 20 (58.82) | 10 (58.82) | 10 (58.82) | 1.00 |
ECOG PS | 1.00 | |||
0 | 6 (17.65) | 3 (17.65) | 3 (17.65) | |
1 | 11 (32.35) | 6 (35.29) | 5 (29.41) | |
2 | 4 (11.76) | 2 (11.76) | 2 (11.76) | |
Unknown | 13 (38.24) | 6 (35.29) | 7 (41.18) | |
History of Immunosuppressive Use | 2 (5.88) | 0 (0.00) | 2 (11.76) | 0.48 |
History of Solid or Hematopoietic Cell Transplant | 3 (8.82) | 1 (5.88) | 2 (11.76) | 1.00 |
Patients with Chronic Infection | 21 (61.76) | 13 (76.47) | 8 (47.06) | 0.16 |
Hepatitis B Only | 1 (2.94) | 1 (5.88) | ||
Hepatitis C Only | 14 (41.17) | 8 (47.06) | 6 (35.29) | |
Hepatitis B and C | 3 (8.82) | 2 (11.76) | 1 (5.88) | |
Hepatitis B and Latent TB | 1 (2.94) | 1 (5.88) | ||
Hepatitis B and C and Latent TB | 1 (2.94) | 1 (5.88) | ||
HSV | 1 (2.94) | 1 (5.88) | ||
Number of Cycles of ICIs Given | 7 (3–13) | 4 (3–12) | 12 (5–17) | 0.18 |
Line of Systemic Therapy | 0.36 | |||
1 | 25 (73.53) | 14 (82.35) | 11 (64.71) | |
2 | 6 (17.65) | 3 (17.65) | 3 (17.65) | |
>2 | 3 (8.82) | 0 (0.00) | 3 (17.65) | |
Rifaximin at ICI Initiation | 4 (11.76) | 1 (5.88) | 3 (17.65) | 0.60 |
Patients on Antibiotic | 8 (23.53) | 3 (17.65) | 5 (29.41) | 0.69 |
IrAE | 10 (29.41) | 4 (23.53) | 6 (35.29) | 0.71 |
Steroids for irAE | 4 (28.57) | 2 (33.33) | 2 (25.00) | 1.00 |
Number of ED Visits | 0.64 | |||
0 | 24 (70.59) | 13 (76.47) | 11 (64.71) | |
1 | 4 (11.76) | 1 (5.88) | 3 (17.65) | |
2 | 5 (14.71) | 3 (17.65) | 2 (11.76) | |
5 | 1 (2.94) | 0 (0.00) | 1 (5.88) | |
Number of Inpatient Hospitalizations | 1 (0–2) | 1 (0–1) | 1 (0–4) | 0.098 |
ICU Admissions | 5 (14.71) | 0 (0.00) | 5 (29.41) | 0.044 |
Number of Reported Infections | ||||
1 | 8 (47.06) | |||
2 | 5 (29.41) | |||
3 | 2 (11.76) | |||
>3 | 2 (11.76) | |||
Bacterial | 12 (70.59) | |||
Infection Causing Treatment Delays/Interruptions | 11 (64.71) | |||
Infection Resulting in Treatment Discontinuation | 7 (41.18) |
OR (95% CI) | p-Value | |
---|---|---|
Age | 1.06 (0.97–1.1) | 0.178 |
Sex | 5 | |
Male | Ref | |
Female | 0.43 (0.07, 2.76) | 0.376 |
Race | ||
White | Ref | |
Other | 0.51 (0.10, 2.61) | 0.423 |
Comorbidities | 1.00 (0.26, 3.92) | 1.000 |
ECOG PS | ||
0 | Ref | |
1 | 0.83 (0.11, 6.11) | 0.858 |
2 | 1.00 (0.08, 12.56) | 1.000 |
Unknown | 1.17 (0.17, 8.09) | 0.876 |
History of Immunosuppressive Use | NA | |
History of Solid or Hematopoietic Cell Transplant | 2.13 (0.17, 26.03) | 0.553 |
Chronic Infection | 0.27 (0.06, 1.19) | 0.084 |
Number of Cycles ICIs Given | 1.06 (0.97–1.15) | 0.178 |
Line of Systemic Therapy | ||
1 | Ref | |
2 | 1.27 (0.21, 7.58) | 0.791 |
>2 | NA | |
Rifaximin at ICI Initiation | 3.43 (0.32, 36.83) | 0.309 |
Was the Patient on Antibiotic | 1.94 (0.38, 9.88) | 0.423 |
IrAE | 1.77 (0.40, 7.93) | 0.454 |
Steroids for irAE | 0.67 (0.06, 6.87) | 0.733 |
ED Visits | 1.77 (0.40, 7.93) | 0.454 |
Inpatient Hospitalizations | 2.13 (0.52, 8.76) | 0.293 |
ICU Admissions | NA |
Death | PFS | |||
---|---|---|---|---|
HR (95% CI) | p-Value | HR (95% CI) | p-Value | |
Infection | 0.93 (0.38–2.29) | 0.873 | 1.04 (0.46, 2.39) | 0.917 |
Age | 1.04 (0.99–1.10) | 0.097 | 1.02 (0.97–1.07) | 0.460 |
Sex | ||||
Male | Ref | |||
Female | 0.28 (0.04, 2.10) | 0.215 | 1.11 (0.33, 3.79) | 0.864 |
Race | 0.69 | |||
White | Ref | |||
Other | 0.49 (0.14, 1.70) | 0.261 | 0.29 (0.08, 1.00) | 0.050 |
Comorbidities | 1.31 (0.51, 3.35) | 0.568 | 1.12 (0.48, 2.59) | 0.795 |
ECOG PS | 1.00 | |||
0 | Ref | Ref | ||
1 | 0.79 (0.22–2.86) | 0.725 | 0.39 (0.12, 1.33) | 0.134 |
2 | 0.39 (0.04–3.52) | 0.401 | 0.57 (0.11, 3.00) | 0.506 |
5 | 0.90 (0.27–3.03) | 0.868 | 0.77 (0.26, 2.30) | 0.644 |
History of Immunosuppressive Use | 11.32 (1.87, 68.44) | 0.008 * | 3.64 (0.79, 16.70) | 0.097 |
History of Solid or Hematopoietic Cell Transplant | 0.97 (0.22, 4.25) | 0.969 | 0.67 (0.16, 2.91) | 0.595 |
Chronic Infection | 0.54 (0.22, 1.33) | 0.178 | 0.52 (0.23, 1.20) | 0.126 |
Number of ICI Cycles Given | 0.88 (0.81–0.95) | 0.002 * | 0.85 (0.78–0.93) | <0.001 * |
Line of Systemic Therapy | ||||
1 | Ref | Ref | ||
2 | 0.69 (0.20–2.43) | 0.567 | 0.89 (0.30, 2.66) | 0.838 |
>2 | 1.29 (0.29–5.74) | 0.742 | 1.07 (0.25, 4.71) | 0.924 |
Rifaximin at ICI Initiation | 2.24 (0.64, 7.80) | 0.204 | 1.32 (0.39, 4.45) | 0.656 |
Antibiotic Use | 1.13 (0.40, 3.18) | 0.812 | 1.66 (0.68, 4.04) | 0.267 |
IrAE | 0.66 (0.23, 1.89) | 0.438 | 0.69 (0.27, 1.76) | 0.439 |
Steroids for irAE | 0.63 (0.13, 3.06) | 0.569 | 0.40 (0.08, 1.92) | 0.253 |
ED Visits | 0.50 (0.17, 1.53) | 0.226 | 0.30 (0.10, 0.90) | 0.032 * |
Inpatient Hospitalizations | 1.10 (0.42, 2.85) | 0.852 | 0.54 (0.24, 1.24) | 0.147 |
ICU Admissions | 3.67 (1.24, 10.86) | 0.019 * | 1.79 (0.65, 4.95) | 0.260 |
Death | 19 (55.88) | 9 (52.94) | 10 (58.82) | 1.0 |
Disease Progressed | 10 (29.41) | 5 (29.41) | 5 (29.41) | 1.0 |
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Esmail, A.; Xu, J.; Burns, E.A.; Abboud, K.; Sheikh, A.; Umoru, G.; Gee, K.; Wiechmann, C.; Zhang, Y.; Abdelrahim, M. The Impact of Infections in Patients Treated with Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma. J. Clin. Med. 2024, 13, 4994. https://doi.org/10.3390/jcm13174994
Esmail A, Xu J, Burns EA, Abboud K, Sheikh A, Umoru G, Gee K, Wiechmann C, Zhang Y, Abdelrahim M. The Impact of Infections in Patients Treated with Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma. Journal of Clinical Medicine. 2024; 13(17):4994. https://doi.org/10.3390/jcm13174994
Chicago/Turabian StyleEsmail, Abdullah, Jiaqiong Xu, Ethan A. Burns, Karen Abboud, Ali Sheikh, Godsfavour Umoru, Kelly Gee, Catherine Wiechmann, Yuqi Zhang, and Maen Abdelrahim. 2024. "The Impact of Infections in Patients Treated with Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma" Journal of Clinical Medicine 13, no. 17: 4994. https://doi.org/10.3390/jcm13174994