Patterns of failure and treatment for hepatocellular carcinoma after immune checkpoint inhibitors.

e16243 Background: Immune checkpoint inhibitors (ICIs) have become a promising approach for hepatocellular carcinoma (HCC). However, there is limited data available on the patterns of failure associated with ICIs, and the optimal approach for subsequent treatment remains controversial. Methods: A cohort of 150 HCC patients treated with ICIs were retrospectively analyzed. The patterns of disease progression were assessed using RECIST criteria 1.1. Chi-square tests and Fisher’s exact tests were employed to explore failure patterns in different populations. Kaplan–Meier method and log-rank test were used to perform survival analyses of different progression patterns and subsequent treatment strategies. Results: The median progression-free survival (PFS) and overall survival (OS) was 7.7 months and 19.6 months, respectively. Patients without lung metastasis had median longer PFS (9.9 vs. 4.2 months, P < 0.001) and OS (26.1 vs. 14.7 months, P < 0.001). Patients treated with 2nd and 3rd line immunotherapy had longer median PFS (9.9 vs. 5.2 vs. 1.5 months, P = 0.001) and OS (25.3 vs. 15.9 vs. 9.8 months, P < 0.001) than those treated with 1st or 4th line immunotherapy. Patients exhibiting alpha-fetoprotein (AFP) levels ≥ 400ng/mL experienced a notably shorter median PFS (6.7 vs. 9.9 months, P = 0.028). With the follow-up period of 27.0 months, 135 (90.0%) patients experienced disease progression. Among these patients, 77 (57.0%) patients developed progression in new lesions, and 86 (63.7%) patients showed oligoprogression. The most common lesion of progression was the liver (n = 75, 55.6%). The patients with oligoprogression had longer median OS (21.4 vs. 12.8 months, P = 0.008) and PFS (8.8 vs. 3.8 months, P < 0.001) than those with systemic progression. After oligoprogression, patients receiving a combination of local therapy with systemic therapy displayed prolonged median OS compared with those receiving only systemic therapy (26.3 vs. 15.2 months, P = 0.04). Conclusions: The PFS and OS were strongly associated with lung metastasis status, AFP levels and the lines of immunotherapy in HCC patients with immunotherapy. Oligoprogression, especially liver, is the most common failure pattern of immunotherapy. The patients receiving a combination of local therapy with systemic therapy could acquire significant survival benefits, which may be an optimal regimen for the patients after oligoprogression.