CRAFITY score and nomogram predict the clinical efficacy of lenvatinib combined with immune checkpoint inhibitors in hepatocellular carcinoma

• Published in: World journal of gastroenterology : WJG Vol. 31; no. 7; p. 101672
• Main Authors: Yin, Xue, Deng, Na, Ding, Xiao-Yan, Chen, Jing-Long, Sun, Wei
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.02.2025
• Subjects: Adult; Aged; alpha-Fetoproteins - analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Female; Humans; Immune Checkpoint Inhibitors - administration & dosage; Immune Checkpoint Inhibitors - therapeutic use; Kaplan-Meier Estimate; Liver Neoplasms - blood; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Male; Middle Aged; Nomograms; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - therapeutic use; Predictive Value of Tests; Prognosis; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Progression-Free Survival; Quinolines - administration & dosage; Quinolines - therapeutic use; Retrospective Studies; Retrospective Study; Treatment Outcome; Hepatocellular carcinoma; Immune checkpoint inhibitors; Lenvatinib; C-reactive protein; Alpha-fetoprotein
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v31.i7.101672

BACKGROUND The CRAFITY score is mainly utilized for hepatocellular carcinoma (HCC) patients receiving atezolizumab and bevacizumab, with little investigation in its predictive capacity for alternative regimens, such as lenvatinib and programmed cell death protein 1 (PD-1) inhibitors, which are widely utilized in Chinese clinical practice. AIM To look at the predictive significance of the CRAFITY score in HCC patients taking lenvatinib and PD-1 inhibitors. METHODS The retrospective investigation consisted of 192 patients with incurable HCC who received lenvatinib and PD-1 inhibitors between January 2018 and January 2022. Patients were stratified according to CRAFITY score (based on baseline alpha-fetoprotein and C-reactive protein levels) into CRAFITY-low, CRAFITY-intermediate, and CRAFITY-high groups. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier analysis, and independent prognostic factors were identified through Cox regression analysis. Nomograms were created to forecast survival for a year. RESULTS The median PFS and OS were the longest for patients in the CRAFITY-low group, followed by those in the CRAFITY-intermediate and CRAFITY-high groups (median PFS: 8.4 months, 6.0 months, and 3.1 months, P < 0.0001; median OS: 33.4 months, 19.2 months, and 6.6 months, P < 0.0001). Both the objective response rate (5%, 19.6%, and 22%, P = 0.0669) and the disease control rate (50%, 76.5%, and 80%, P = 0.0023) were considerably lower in the CRAFITY-high group. The findings from the multivariate analysis showed that a nomogram which included the tumor number, prior transarterial chemoembolization history, and CRAFITY score predicted 12-month survival with an area under the curve of 0.788 (95% confidence interval: 0.718-0.859), which was in good agreement with actual data. CONCLUSION The CRAFITY score is a valuable predictor of survival and treatment outcomes in patients receiving lenvatinib and PD-1 inhibitors.