Ian Tobal, DO, Ochsner Medical Center, New Orleans, Louisiana, shares results from a single-center real world data analysis evaluating the outcomes of real-world patients, with Child-Pugh scores worse than A, who were treated with either atezolizumab plus bevacizumab or durvalumab plus tremelimumab at the Ochsner Medical Center between 2020 and 2023.

These data were first presented at the 2025 ASCO Gastrointestinal Cancers Symposium in San Francisco, California.

Transcript:

Hello, my name is Ian Tobel and I'm a PGY-2 at Ochsner Medical Center in New Orleans. The title of my project was "Real World Child-Pugh Scores and Outcomes of Patients with Hepatocellular Carcinoma at a High-Volume Center" [presented at 2025 ASCO Gastrointestinal Cancers Symposium]. For our project, we looked at the Child-Pugh scores of patients using immunotherapies for unresectable HCC, hepatocellular carcinoma. The reason we wanted to do this, we wanted to better describe the real-world population of patients receiving these drugs, especially in terms of Child-Pugh scoring, because a lot of the landmark trials that established these immunotherapy regimens did not include patients who had Child-Pugh scores worse than A. So we wanted to better define the real-world population of these patients and also see how survival time and rates were related to the different Child-Pugh scores at the time of treatment. 

We were able to find 200 patients with unresectable hepatocellular carcinoma who were receiving first-line immunotherapies, either atezolizumab and bevacizumab or durvalumab and tremelimumab. We calculated their Child-Pugh scores at the time of their first medical oncology appointment, and again, at the time of treatment, starting with these immunotherapy regimens. What we found was that at the time of the first appointment with medical oncology, about 29% of patients were Child-Pugh Class B or C. And at the time of treatment, start with immunotherapy, 41% of patients were Child-Pugh Class B or C. Along with the progression of Child-Pugh scoring in advancement of liver disease, we found that there was a worse prognosis and worse survival time. As Child-Pugh scores progressed from A to B to C. 

One of the most significant findings was that there was a significant proportion of people who had progression of their liver disease between the first appointment with medical oncology and the beginning of treatment start with immunotherapy. We felt that really emphasized the need to quickly start treatment and limit any delays that may come with it, because we do find that patients progress and as their liver disease progresses, they have worse survival times and worse outcomes. Particularly in Child-Pugh Class C patients, that had a 0% 6-month survival rate and a 0% 12-month survival rate intuitively. I think it really emphasizes the point that treatment should be started as soon as possible. 

This information also argues that patients with Child-Pugh Class C patients may not benefit from starting treatment at all, with such poor prognosis and outcomes, in terms of survival. One thing that we did find in our data is when we put patients into [Child-Pugh Class] A, B, or C at either first medical appointment with medical oncology or treatment at the time of treatment start, we found that there was about an 11% increase from Child-Pugh Class A to Child-Pugh Class B and C. But when we actually broke down the numbers to see how many patients had progressed, we found that it was actually a higher percentage than that. We found that 38 patients of our 200, or just about just shy of 20%, had progression of liver disease. The overall population percentages in each of those groups at a different times doesn't necessarily reflect that percentage increase because there was also some people that had improvement in their Child-Pugh score. I think that's an important thing, that it is a larger percentage than we had initially anticipated that we're actually showing progression of liver disease between these 2 time points.

I think the main takeaways from this study is that the real world population of patients being treated for unresectable hepatocellular carcinoma with immunotherapies, that a significant proportion of them are Child-Pugh Class B and C, and that does carry a worse survival rate and prognosis. And in general, from what we found, we argue that Child-Pugh Class C patients may not benefit at all or significantly enough to go through this therapy and use of these agents in that population may not be beneficial.

Source:

Tobal I, Shuaibi S, Biggs E, Mizrahi J. Real-world Child-Pugh scores and outcomes of patients with hepatocellular carcinoma at a high-volume center. Presented at the 2025 ASCO GI Cancers Symposium. January 23-25, 2025; San Francisco, CA. Abstract 569.