Article

Edoardo Caronna, MD and Patricia Pozo-Rosich, MD, PhD,  Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; and Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. Dr. Pozo-Rosich also serves on the boards of the International Headache Society and Council of the European Headache Federation and is an editor for various peer-reviewed journals, including Cephalalgia and Headache.

Headache is a symptom of the coronavirus disease 2019 (Covid-19), caused by the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the pandemic began, researchers have tried to describe, understand, and help clinicians manage headache in the setting of Covid-19.

The reason is simple: Headache is common, often debilitating, and difficult to treat.¹

Moreover, headache could manifest both in the acute phase of the infection and, once the infection has resolved, in the post-acute phase.¹ Therefore, it is critical for clinicians to know more about headache, as headache can be a common reason that patients seek help, both in the specialized and non-specialized medical care setting.

Definitions and manifestations

While the first step in such a communication would be to define headache attributed to Covid-19, no specific definition exists, as this is a new disease. Therefore, headache attributed to Covid-19 should be defined under the diagnostic criteria, as contained in the International Classification of Headache Disorders-3, as headache attributed to a systemic viral infection.² As this is a secondary headache appearing with an infection, the treating physician needs to rule out possible underlying meningitis and/or encephalitis in the diagnosis. Moreover, other secondary headaches (eg, cerebral venous thrombosis) may appear, so clinicians need to carefully evaluate patients with headache during Covid-19 to detect signs or symptoms that point to other etiologies.

It is also advisable to know the clinical manifestations of headache attributed to Covid-19. Studies published so far have observed two main phenotypes of headache in the acute phase of the infection: one resembles migraine, the other, a tension-type headache.^1,3 Although patients with history of migraine who contract Covid-19 report headache that is more similar to primary headache disorder,⁴ two relevant aspects should be considered. Namely, migraine-like features can be observed in patients without personal migraine history; and Covid-19 patients with such history may perceive that headache they experience in the infection’s acute phase differs from their usual experience, especially regarding increased severity or duration.^5,6 Of note, headache can be a prodromal symptom of the SARS-CoV-2 infection.¹

Evolution of a headache

 Because headache appearing after the acute phase of the infection can persist, often manifesting migraine-like features, it is inordinately helpful for clinicians to know its evolution.¹ This persistent headache, sometimes referred to as post-covid headache, is not aptly named because the post-covid headache is not just one type of headache, but instead can manifest as different headache types.

 A recently published case series in Headache discussed three Covid patients who all experienced persistent headache during the infection’s post-acute phase.⁷ These patients experienced a migraine-like phenotype as have others with mild Covid-19, but their personal history of migraine, as well as their experience with Covid-19 related headache, were substantially different. Some patients had personal migraine history while others did not; some patients experienced no headache in the acute phase but did so in the post-acute phase; and the concomitant symptoms of the post-acute phase, such as insomnia, memory loss, dizziness, fatigue, and brain fog, were differentially expressed by patients.⁷ 

 This case series introduces the concept that patients with no prior history of migraine or any other primary headache disorder can develop a de novo headache because of their SARS-CoV-2 infection. Moreover, it could manifest as a new daily persistent headache. And patients with personal history of migraine may experience sudden chronification in their headache’s characteristics, rather than develop a new type of headache.⁷

 In another study, soon to be published in Cephalalgia, researchers observed that the median duration of headache in the acute phase is 2 weeks. This multicenter Spanish study, in which data on headache duration were available for 874 patients, found that 16% of these particular patients had persistent headache after 9 months. According to this study, headache that does not resolve within the first 3 months is less likely to do so later on.

Treatment

For clinicians, the significance of these findings is straightforward: Patients with headache experienced in the infection’s acute phase that does not seem to resolve post-infection requires continued medical attention. Patients should be monitored, carefully managed, and treated to avoid the onset of a persisting headache. This applies to patients with or without personal migraine history.

But which treatments should be prescribed? As there are no specific therapies for headache attributed to Covid-19, either in the acute or post-acute phase of the infection, clinicians must turn to existing therapies.

As with patients with migraine, patients with persistent headache post-Covid infection need a headache prevention strategy.

The strategy should be based on the following principles:

• treat headache
• treat comorbidities including mood disorders,  insomnia, and so on
• avoid complications such as medication overuse, which may be very common in these patients.

Acute medications

Despite the lack of specific literature on this matter, migraine-like phenotypes may respond to triptans and probably, where available, lasmiditan and gepants. These medications probably represent a therapeutic option for Covid patients with headache, but before prescribing them clinicians should carefully evaluate their use.

Before deciding on the prescription, clinicians should consider not only the medications’ most common contraindications, but also those that are related to Covid-19: the phase of the infection (acute/post-acute); the infection’s severity; and the presence of other Covid-related health problems. The concerns over the use of nonsteroidal anti-inflammatory medications (NSAIDs) and corticosteroids, raised when the pandemic first struck, have greatly dissipated.^8,9 Some patients with prolonged headache may benefit from a brief cycle of corticosteroids, similar to the treatment given to those patients with status migrainosus. Nerve blocks could also be considered.

Preventive medications

Drugs can be prescribed according to the headache phenotype too, but there are no published studies that specifically evaluate headache prevention treatments in patients with persistent headache post-infection. The case series mentioned earlier in this article recorded that patients whose headaches were treated with amitriptyline and onabotulinumtoxinA had reported variable treatment responses to this regimen, according to the patients’ characteristics.⁷

However, one important question regarding the safety of Covid patients with migraine – specifically patients on preventive treatments during the infection’s acute phase – has been somewhat resolved.

Medications such as renin-angiotensin system (RAS) blockers, suspected of possible involvement in the SARs-CoV-2 pathogenicity, seem to be safe.^8,10 And, in another multicenter Spanish study, researchers found that the use of anti-CGRP monoclonal antibodies did not seem to be associated with worse Covid-19 outcomes despite the possible implication of CGRP in modulating inflammatory responses during a viral infection.¹¹

The study of anti-CGRP monoclonal antibodies could be important in the future for another reason: To see whether these medications could be effective as a preventive treatment in patients with persistent headache after Covid-19, regardless of whether these patients have personal migraine history.

An interesting and important message to close this article. Although headache experienced in the infection’s acute phase could be extremely disabling for patients, the evidence points to the presence of headache as a marker of a better Covid-19 prognosis, in terms of a shorter infection period and a lower risk of mortality among hospitalized patients.^1,3,12  

This brief communication contains current information to help clinicians treat and inform their patients with Covid-sourced headache. Yet, we must keep in mind that the majority of the data reported here and published in the literature refer to studies conducted during the first wave of the pandemic. The emergence of new SARS-CoV-2 variants and vaccines have enormously changed the disease’s clinical presentation and course, so future studies are warranted to re-assess the validity of these findings under new conditions.

Edoardo Caronna, MD and Patricia Pozo-Rosich, MD, PhD,  Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; and Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. Dr. Pozo-Rosich also serves on the boards of the International Headache Society and Council of the European Headache Federation and is an editor for various peer-reviewed journals, including Cephalalgia and Headache.

Headache is a symptom of the coronavirus disease 2019 (Covid-19), caused by the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the pandemic began, researchers have tried to describe, understand, and help clinicians manage headache in the setting of Covid-19.

The reason is simple: Headache is common, often debilitating, and difficult to treat.¹

Moreover, headache could manifest both in the acute phase of the infection and, once the infection has resolved, in the post-acute phase.¹ Therefore, it is critical for clinicians to know more about headache, as headache can be a common reason that patients seek help, both in the specialized and non-specialized medical care setting.

Definitions and manifestations

While the first step in such a communication would be to define headache attributed to Covid-19, no specific definition exists, as this is a new disease. Therefore, headache attributed to Covid-19 should be defined under the diagnostic criteria, as contained in the International Classification of Headache Disorders-3, as headache attributed to a systemic viral infection.² As this is a secondary headache appearing with an infection, the treating physician needs to rule out possible underlying meningitis and/or encephalitis in the diagnosis. Moreover, other secondary headaches (eg, cerebral venous thrombosis) may appear, so clinicians need to carefully evaluate patients with headache during Covid-19 to detect signs or symptoms that point to other etiologies.

It is also advisable to know the clinical manifestations of headache attributed to Covid-19. Studies published so far have observed two main phenotypes of headache in the acute phase of the infection: one resembles migraine, the other, a tension-type headache.^1,3 Although patients with history of migraine who contract Covid-19 report headache that is more similar to primary headache disorder,⁴ two relevant aspects should be considered. Namely, migraine-like features can be observed in patients without personal migraine history; and Covid-19 patients with such history may perceive that headache they experience in the infection’s acute phase differs from their usual experience, especially regarding increased severity or duration.^5,6 Of note, headache can be a prodromal symptom of the SARS-CoV-2 infection.¹

Evolution of a headache

 Because headache appearing after the acute phase of the infection can persist, often manifesting migraine-like features, it is inordinately helpful for clinicians to know its evolution.¹ This persistent headache, sometimes referred to as post-covid headache, is not aptly named because the post-covid headache is not just one type of headache, but instead can manifest as different headache types.

 A recently published case series in Headache discussed three Covid patients who all experienced persistent headache during the infection’s post-acute phase.⁷ These patients experienced a migraine-like phenotype as have others with mild Covid-19, but their personal history of migraine, as well as their experience with Covid-19 related headache, were substantially different. Some patients had personal migraine history while others did not; some patients experienced no headache in the acute phase but did so in the post-acute phase; and the concomitant symptoms of the post-acute phase, such as insomnia, memory loss, dizziness, fatigue, and brain fog, were differentially expressed by patients.⁷ 

 This case series introduces the concept that patients with no prior history of migraine or any other primary headache disorder can develop a de novo headache because of their SARS-CoV-2 infection. Moreover, it could manifest as a new daily persistent headache. And patients with personal history of migraine may experience sudden chronification in their headache’s characteristics, rather than develop a new type of headache.⁷

 In another study, soon to be published in Cephalalgia, researchers observed that the median duration of headache in the acute phase is 2 weeks. This multicenter Spanish study, in which data on headache duration were available for 874 patients, found that 16% of these particular patients had persistent headache after 9 months. According to this study, headache that does not resolve within the first 3 months is less likely to do so later on.

Treatment

For clinicians, the significance of these findings is straightforward: Patients with headache experienced in the infection’s acute phase that does not seem to resolve post-infection requires continued medical attention. Patients should be monitored, carefully managed, and treated to avoid the onset of a persisting headache. This applies to patients with or without personal migraine history.

But which treatments should be prescribed? As there are no specific therapies for headache attributed to Covid-19, either in the acute or post-acute phase of the infection, clinicians must turn to existing therapies.

As with patients with migraine, patients with persistent headache post-Covid infection need a headache prevention strategy.

The strategy should be based on the following principles:

• treat headache
• treat comorbidities including mood disorders,  insomnia, and so on
• avoid complications such as medication overuse, which may be very common in these patients.

Acute medications

Despite the lack of specific literature on this matter, migraine-like phenotypes may respond to triptans and probably, where available, lasmiditan and gepants. These medications probably represent a therapeutic option for Covid patients with headache, but before prescribing them clinicians should carefully evaluate their use.

Before deciding on the prescription, clinicians should consider not only the medications’ most common contraindications, but also those that are related to Covid-19: the phase of the infection (acute/post-acute); the infection’s severity; and the presence of other Covid-related health problems. The concerns over the use of nonsteroidal anti-inflammatory medications (NSAIDs) and corticosteroids, raised when the pandemic first struck, have greatly dissipated.^8,9 Some patients with prolonged headache may benefit from a brief cycle of corticosteroids, similar to the treatment given to those patients with status migrainosus. Nerve blocks could also be considered.

Preventive medications

Drugs can be prescribed according to the headache phenotype too, but there are no published studies that specifically evaluate headache prevention treatments in patients with persistent headache post-infection. The case series mentioned earlier in this article recorded that patients whose headaches were treated with amitriptyline and onabotulinumtoxinA had reported variable treatment responses to this regimen, according to the patients’ characteristics.⁷

However, one important question regarding the safety of Covid patients with migraine – specifically patients on preventive treatments during the infection’s acute phase – has been somewhat resolved.

Medications such as renin-angiotensin system (RAS) blockers, suspected of possible involvement in the SARs-CoV-2 pathogenicity, seem to be safe.^8,10 And, in another multicenter Spanish study, researchers found that the use of anti-CGRP monoclonal antibodies did not seem to be associated with worse Covid-19 outcomes despite the possible implication of CGRP in modulating inflammatory responses during a viral infection.¹¹

The study of anti-CGRP monoclonal antibodies could be important in the future for another reason: To see whether these medications could be effective as a preventive treatment in patients with persistent headache after Covid-19, regardless of whether these patients have personal migraine history.

An interesting and important message to close this article. Although headache experienced in the infection’s acute phase could be extremely disabling for patients, the evidence points to the presence of headache as a marker of a better Covid-19 prognosis, in terms of a shorter infection period and a lower risk of mortality among hospitalized patients.^1,3,12  

This brief communication contains current information to help clinicians treat and inform their patients with Covid-sourced headache. Yet, we must keep in mind that the majority of the data reported here and published in the literature refer to studies conducted during the first wave of the pandemic. The emergence of new SARS-CoV-2 variants and vaccines have enormously changed the disease’s clinical presentation and course, so future studies are warranted to re-assess the validity of these findings under new conditions.

Edoardo Caronna, MD and Patricia Pozo-Rosich, MD, PhD,  Neurology Department, Hospital Universitari Vall d’Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; and Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. Dr. Pozo-Rosich also serves on the boards of the International Headache Society and Council of the European Headache Federation and is an editor for various peer-reviewed journals, including Cephalalgia and Headache.

Headache is a symptom of the coronavirus disease 2019 (Covid-19), caused by the novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the pandemic began, researchers have tried to describe, understand, and help clinicians manage headache in the setting of Covid-19.

The reason is simple: Headache is common, often debilitating, and difficult to treat.¹

Moreover, headache could manifest both in the acute phase of the infection and, once the infection has resolved, in the post-acute phase.¹ Therefore, it is critical for clinicians to know more about headache, as headache can be a common reason that patients seek help, both in the specialized and non-specialized medical care setting.

Definitions and manifestations

While the first step in such a communication would be to define headache attributed to Covid-19, no specific definition exists, as this is a new disease. Therefore, headache attributed to Covid-19 should be defined under the diagnostic criteria, as contained in the International Classification of Headache Disorders-3, as headache attributed to a systemic viral infection.² As this is a secondary headache appearing with an infection, the treating physician needs to rule out possible underlying meningitis and/or encephalitis in the diagnosis. Moreover, other secondary headaches (eg, cerebral venous thrombosis) may appear, so clinicians need to carefully evaluate patients with headache during Covid-19 to detect signs or symptoms that point to other etiologies.

It is also advisable to know the clinical manifestations of headache attributed to Covid-19. Studies published so far have observed two main phenotypes of headache in the acute phase of the infection: one resembles migraine, the other, a tension-type headache.^1,3 Although patients with history of migraine who contract Covid-19 report headache that is more similar to primary headache disorder,⁴ two relevant aspects should be considered. Namely, migraine-like features can be observed in patients without personal migraine history; and Covid-19 patients with such history may perceive that headache they experience in the infection’s acute phase differs from their usual experience, especially regarding increased severity or duration.^5,6 Of note, headache can be a prodromal symptom of the SARS-CoV-2 infection.¹

Evolution of a headache

 Because headache appearing after the acute phase of the infection can persist, often manifesting migraine-like features, it is inordinately helpful for clinicians to know its evolution.¹ This persistent headache, sometimes referred to as post-covid headache, is not aptly named because the post-covid headache is not just one type of headache, but instead can manifest as different headache types.

 A recently published case series in Headache discussed three Covid patients who all experienced persistent headache during the infection’s post-acute phase.⁷ These patients experienced a migraine-like phenotype as have others with mild Covid-19, but their personal history of migraine, as well as their experience with Covid-19 related headache, were substantially different. Some patients had personal migraine history while others did not; some patients experienced no headache in the acute phase but did so in the post-acute phase; and the concomitant symptoms of the post-acute phase, such as insomnia, memory loss, dizziness, fatigue, and brain fog, were differentially expressed by patients.⁷ 

 This case series introduces the concept that patients with no prior history of migraine or any other primary headache disorder can develop a de novo headache because of their SARS-CoV-2 infection. Moreover, it could manifest as a new daily persistent headache. And patients with personal history of migraine may experience sudden chronification in their headache’s characteristics, rather than develop a new type of headache.⁷

 In another study, soon to be published in Cephalalgia, researchers observed that the median duration of headache in the acute phase is 2 weeks. This multicenter Spanish study, in which data on headache duration were available for 874 patients, found that 16% of these particular patients had persistent headache after 9 months. According to this study, headache that does not resolve within the first 3 months is less likely to do so later on.

Treatment

For clinicians, the significance of these findings is straightforward: Patients with headache experienced in the infection’s acute phase that does not seem to resolve post-infection requires continued medical attention. Patients should be monitored, carefully managed, and treated to avoid the onset of a persisting headache. This applies to patients with or without personal migraine history.

But which treatments should be prescribed? As there are no specific therapies for headache attributed to Covid-19, either in the acute or post-acute phase of the infection, clinicians must turn to existing therapies.

As with patients with migraine, patients with persistent headache post-Covid infection need a headache prevention strategy.

The strategy should be based on the following principles:

• treat headache
• treat comorbidities including mood disorders,  insomnia, and so on
• avoid complications such as medication overuse, which may be very common in these patients.

Acute medications

Despite the lack of specific literature on this matter, migraine-like phenotypes may respond to triptans and probably, where available, lasmiditan and gepants. These medications probably represent a therapeutic option for Covid patients with headache, but before prescribing them clinicians should carefully evaluate their use.

Before deciding on the prescription, clinicians should consider not only the medications’ most common contraindications, but also those that are related to Covid-19: the phase of the infection (acute/post-acute); the infection’s severity; and the presence of other Covid-related health problems. The concerns over the use of nonsteroidal anti-inflammatory medications (NSAIDs) and corticosteroids, raised when the pandemic first struck, have greatly dissipated.^8,9 Some patients with prolonged headache may benefit from a brief cycle of corticosteroids, similar to the treatment given to those patients with status migrainosus. Nerve blocks could also be considered.

Preventive medications

Drugs can be prescribed according to the headache phenotype too, but there are no published studies that specifically evaluate headache prevention treatments in patients with persistent headache post-infection. The case series mentioned earlier in this article recorded that patients whose headaches were treated with amitriptyline and onabotulinumtoxinA had reported variable treatment responses to this regimen, according to the patients’ characteristics.⁷

However, one important question regarding the safety of Covid patients with migraine – specifically patients on preventive treatments during the infection’s acute phase – has been somewhat resolved.

Medications such as renin-angiotensin system (RAS) blockers, suspected of possible involvement in the SARs-CoV-2 pathogenicity, seem to be safe.^8,10 And, in another multicenter Spanish study, researchers found that the use of anti-CGRP monoclonal antibodies did not seem to be associated with worse Covid-19 outcomes despite the possible implication of CGRP in modulating inflammatory responses during a viral infection.¹¹

The study of anti-CGRP monoclonal antibodies could be important in the future for another reason: To see whether these medications could be effective as a preventive treatment in patients with persistent headache after Covid-19, regardless of whether these patients have personal migraine history.

An interesting and important message to close this article. Although headache experienced in the infection’s acute phase could be extremely disabling for patients, the evidence points to the presence of headache as a marker of a better Covid-19 prognosis, in terms of a shorter infection period and a lower risk of mortality among hospitalized patients.^1,3,12  

This brief communication contains current information to help clinicians treat and inform their patients with Covid-sourced headache. Yet, we must keep in mind that the majority of the data reported here and published in the literature refer to studies conducted during the first wave of the pandemic. The emergence of new SARS-CoV-2 variants and vaccines have enormously changed the disease’s clinical presentation and course, so future studies are warranted to re-assess the validity of these findings under new conditions.

Key clinical point: Advanced age and liver stiffness measurement (LSM) on transient elastography, both pretreatment and at 24-week sustained virological response (SVR24), may aid in predicting the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved SVR to interferon (IFN)-free direct-acting antivirals (DAA).

Main finding: Multivariate analysis revealed age ≥71 years (adjusted hazard ratio [aHR] 3.402; P = .005) and LSM ≥9.2 kPa (aHR 6.328; P < .001) to be the significant predictive factors at pretreatment and age ≥71 years (aHR 2.689; P = .014) and LSM ≥8.4 kPa (aHR 6.642; P < .001) at SVR24.

Study details: This was a multicenter retrospective study including 567 patients with no history of HCC but with HCV infection treated with DAAs and who achieved SVR24.

Disclosures: The study was sponsored by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; Japan Society for the Promotion of Science; Japan Agency for Medical Research and Development; and Ministry of Health, Labor, and Welfare of Japan. Some authors declared receiving speaker fees/research grants from various pharmaceutical companies.

Source: Nakai M et al. Sci Rep. 2022;12:1449 (Jan 27). Doi: 10.1038/s41598-022-05492-5.

Key clinical point: Advanced age and liver stiffness measurement (LSM) on transient elastography, both pretreatment and at 24-week sustained virological response (SVR24), may aid in predicting the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved SVR to interferon (IFN)-free direct-acting antivirals (DAA).

Main finding: Multivariate analysis revealed age ≥71 years (adjusted hazard ratio [aHR] 3.402; P = .005) and LSM ≥9.2 kPa (aHR 6.328; P < .001) to be the significant predictive factors at pretreatment and age ≥71 years (aHR 2.689; P = .014) and LSM ≥8.4 kPa (aHR 6.642; P < .001) at SVR24.

Study details: This was a multicenter retrospective study including 567 patients with no history of HCC but with HCV infection treated with DAAs and who achieved SVR24.

Disclosures: The study was sponsored by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; Japan Society for the Promotion of Science; Japan Agency for Medical Research and Development; and Ministry of Health, Labor, and Welfare of Japan. Some authors declared receiving speaker fees/research grants from various pharmaceutical companies.

Source: Nakai M et al. Sci Rep. 2022;12:1449 (Jan 27). Doi: 10.1038/s41598-022-05492-5.

Key clinical point: Advanced age and liver stiffness measurement (LSM) on transient elastography, both pretreatment and at 24-week sustained virological response (SVR24), may aid in predicting the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who achieved SVR to interferon (IFN)-free direct-acting antivirals (DAA).

Main finding: Multivariate analysis revealed age ≥71 years (adjusted hazard ratio [aHR] 3.402; P = .005) and LSM ≥9.2 kPa (aHR 6.328; P < .001) to be the significant predictive factors at pretreatment and age ≥71 years (aHR 2.689; P = .014) and LSM ≥8.4 kPa (aHR 6.642; P < .001) at SVR24.

Study details: This was a multicenter retrospective study including 567 patients with no history of HCC but with HCV infection treated with DAAs and who achieved SVR24.

Disclosures: The study was sponsored by the Ministry of Education, Culture, Sports, Science, and Technology of Japan; Japan Society for the Promotion of Science; Japan Agency for Medical Research and Development; and Ministry of Health, Labor, and Welfare of Japan. Some authors declared receiving speaker fees/research grants from various pharmaceutical companies.

Source: Nakai M et al. Sci Rep. 2022;12:1449 (Jan 27). Doi: 10.1038/s41598-022-05492-5.

Key clinical point: Robot-assisted liver resection (RALR) and laparoscopic liver resection (LLR) show similar long-term oncological outcomes to open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC) along with allowing faster patient recovery.

Main finding: OLR, LLR, and RALR achieved 5-year overall survival rates of 78.6%, 76.8%, and 74.4% (P = .90) and 5-year disease-free survival rates of 57.9%, 51.3%, and 51.8% (P = .64), respectively. Patients undergoing LLR (6 days) or RALR (8 days) vs. OLR (12 days) recovered faster (both P < .001).

Study details: The data come from a single-center prospective study that compared 3 propensity score-matched cohorts of 56 patients each who were aged 14-75 years and received no previous treatment before undergoing either ALR, LLR, or OLR due to BCLC stage 0-A HCC.

Disclosures: The study was supported by the Key Project of Science and Technology in Hubei Province, General Project of Natural Science Foundation of Hubei Province, and General Project of Health Commission of Hubei Province. No conflicts of interest were disclosed.

Source: Zhu P et al. Ann Surg. 2022 (Jan 25). Doi: 10.1097/SLA.0000000000005380.

Key clinical point: Robot-assisted liver resection (RALR) and laparoscopic liver resection (LLR) show similar long-term oncological outcomes to open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC) along with allowing faster patient recovery.

Main finding: OLR, LLR, and RALR achieved 5-year overall survival rates of 78.6%, 76.8%, and 74.4% (P = .90) and 5-year disease-free survival rates of 57.9%, 51.3%, and 51.8% (P = .64), respectively. Patients undergoing LLR (6 days) or RALR (8 days) vs. OLR (12 days) recovered faster (both P < .001).

Study details: The data come from a single-center prospective study that compared 3 propensity score-matched cohorts of 56 patients each who were aged 14-75 years and received no previous treatment before undergoing either ALR, LLR, or OLR due to BCLC stage 0-A HCC.

Disclosures: The study was supported by the Key Project of Science and Technology in Hubei Province, General Project of Natural Science Foundation of Hubei Province, and General Project of Health Commission of Hubei Province. No conflicts of interest were disclosed.

Source: Zhu P et al. Ann Surg. 2022 (Jan 25). Doi: 10.1097/SLA.0000000000005380.

Key clinical point: Robot-assisted liver resection (RALR) and laparoscopic liver resection (LLR) show similar long-term oncological outcomes to open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC) along with allowing faster patient recovery.

Main finding: OLR, LLR, and RALR achieved 5-year overall survival rates of 78.6%, 76.8%, and 74.4% (P = .90) and 5-year disease-free survival rates of 57.9%, 51.3%, and 51.8% (P = .64), respectively. Patients undergoing LLR (6 days) or RALR (8 days) vs. OLR (12 days) recovered faster (both P < .001).

Study details: The data come from a single-center prospective study that compared 3 propensity score-matched cohorts of 56 patients each who were aged 14-75 years and received no previous treatment before undergoing either ALR, LLR, or OLR due to BCLC stage 0-A HCC.

Disclosures: The study was supported by the Key Project of Science and Technology in Hubei Province, General Project of Natural Science Foundation of Hubei Province, and General Project of Health Commission of Hubei Province. No conflicts of interest were disclosed.

Source: Zhu P et al. Ann Surg. 2022 (Jan 25). Doi: 10.1097/SLA.0000000000005380.

Key clinical point: In treatment-naive patients with chronic hepatitis B, therapy with tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) is associated with a lower risk of developing hepatocellular carcinoma (HCC) in the future.

Main finding: During the follow-up, patients receiving TDF showed a lower crude HCC incidence rate than those receiving ETV (0.30 vs. 0.62 per 100 person-years). TDF vs. ETV was associated with a significantly reduced risk of HCC occurrence (adjusted subdistribution hazard ratio 0.58; P = .01).

Study details: The data come from a retrospective cohort study including 10,061 adult treatment-naive patients with chronic hepatitis B but no evidence of HCC and who initiated therapy with ETV (n = 3,934) or TDF (n = 6,127).

Disclosures: The study was sponsored by Gilead Sciences. WR Kim, M Lu, and S Gordon declared serving as an advisory board member and consultant for or receiving research funding from Gilead Sciences. The rest of the authors are current or former employees and stockholders of Gilead Sciences.

Source: Kim WR et al. Aliment Pharmacol Ther. 2022 (Feb 8). Doi: 10.1111/apt.16786.

Key clinical point: In treatment-naive patients with chronic hepatitis B, therapy with tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) is associated with a lower risk of developing hepatocellular carcinoma (HCC) in the future.

Main finding: During the follow-up, patients receiving TDF showed a lower crude HCC incidence rate than those receiving ETV (0.30 vs. 0.62 per 100 person-years). TDF vs. ETV was associated with a significantly reduced risk of HCC occurrence (adjusted subdistribution hazard ratio 0.58; P = .01).

Study details: The data come from a retrospective cohort study including 10,061 adult treatment-naive patients with chronic hepatitis B but no evidence of HCC and who initiated therapy with ETV (n = 3,934) or TDF (n = 6,127).

Disclosures: The study was sponsored by Gilead Sciences. WR Kim, M Lu, and S Gordon declared serving as an advisory board member and consultant for or receiving research funding from Gilead Sciences. The rest of the authors are current or former employees and stockholders of Gilead Sciences.

Source: Kim WR et al. Aliment Pharmacol Ther. 2022 (Feb 8). Doi: 10.1111/apt.16786.

Key clinical point: In treatment-naive patients with chronic hepatitis B, therapy with tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) is associated with a lower risk of developing hepatocellular carcinoma (HCC) in the future.

Main finding: During the follow-up, patients receiving TDF showed a lower crude HCC incidence rate than those receiving ETV (0.30 vs. 0.62 per 100 person-years). TDF vs. ETV was associated with a significantly reduced risk of HCC occurrence (adjusted subdistribution hazard ratio 0.58; P = .01).

Study details: The data come from a retrospective cohort study including 10,061 adult treatment-naive patients with chronic hepatitis B but no evidence of HCC and who initiated therapy with ETV (n = 3,934) or TDF (n = 6,127).

Disclosures: The study was sponsored by Gilead Sciences. WR Kim, M Lu, and S Gordon declared serving as an advisory board member and consultant for or receiving research funding from Gilead Sciences. The rest of the authors are current or former employees and stockholders of Gilead Sciences.

Source: Kim WR et al. Aliment Pharmacol Ther. 2022 (Feb 8). Doi: 10.1111/apt.16786.

Key clinical point: Compared with sorafenib alone, its combination with 3cir-OFF hepatic arterial infusion chemotherapy (HAIC) offers significantly prolonged survival and an acceptable safety profile in patients with advanced hepatocellular carcinoma (HCC) and major portal vein tumor thrombosis (PVTT).

Main finding: Sorafenib plus HAIC vs. sorafenib alone led to a longer median overall survival (16.3 months vs. 6.5 months; hazard ratio [HR] 0.28; P < .001) and progression-free survival (9.0 months vs. 2.5 months; HR 0.26; P < .001) but more frequent grade 3/4 adverse events.

Study details: This was a phase 2 study involving adult, systemic treatment-naive patients with inoperable advanced primary HCC and major PVTT who were randomly assigned to receive either sorafenib plus HAIC (n = 32) or sorafenib alone (n = 32).

Disclosures: The study was sponsored by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, Beijing Natural Science Foundation, and National Natural Science Foundation of China. None of the authors reported any conflicts of interest.

Source: Zheng K et al. Radiology. 2022 (Feb 1). Doi: 10.1148/radiol.211545.

Key clinical point: Compared with sorafenib alone, its combination with 3cir-OFF hepatic arterial infusion chemotherapy (HAIC) offers significantly prolonged survival and an acceptable safety profile in patients with advanced hepatocellular carcinoma (HCC) and major portal vein tumor thrombosis (PVTT).

Main finding: Sorafenib plus HAIC vs. sorafenib alone led to a longer median overall survival (16.3 months vs. 6.5 months; hazard ratio [HR] 0.28; P < .001) and progression-free survival (9.0 months vs. 2.5 months; HR 0.26; P < .001) but more frequent grade 3/4 adverse events.

Study details: This was a phase 2 study involving adult, systemic treatment-naive patients with inoperable advanced primary HCC and major PVTT who were randomly assigned to receive either sorafenib plus HAIC (n = 32) or sorafenib alone (n = 32).

Disclosures: The study was sponsored by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, Beijing Natural Science Foundation, and National Natural Science Foundation of China. None of the authors reported any conflicts of interest.

Source: Zheng K et al. Radiology. 2022 (Feb 1). Doi: 10.1148/radiol.211545.

Key clinical point: Compared with sorafenib alone, its combination with 3cir-OFF hepatic arterial infusion chemotherapy (HAIC) offers significantly prolonged survival and an acceptable safety profile in patients with advanced hepatocellular carcinoma (HCC) and major portal vein tumor thrombosis (PVTT).

Main finding: Sorafenib plus HAIC vs. sorafenib alone led to a longer median overall survival (16.3 months vs. 6.5 months; hazard ratio [HR] 0.28; P < .001) and progression-free survival (9.0 months vs. 2.5 months; HR 0.26; P < .001) but more frequent grade 3/4 adverse events.

Study details: This was a phase 2 study involving adult, systemic treatment-naive patients with inoperable advanced primary HCC and major PVTT who were randomly assigned to receive either sorafenib plus HAIC (n = 32) or sorafenib alone (n = 32).

Disclosures: The study was sponsored by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, Beijing Natural Science Foundation, and National Natural Science Foundation of China. None of the authors reported any conflicts of interest.

Source: Zheng K et al. Radiology. 2022 (Feb 1). Doi: 10.1148/radiol.211545.

Key clinical point: Antiviral therapy (AVT)-mediated reduction in liver inflammation and fibrosis is associated with improvement in the long-term outcomes of patients who have undergone hepatectomy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

Main finding: AVT vs. non-AVT patients exhibited significantly higher 5-year recurrence-free survival (RFS) rates (19.1% vs. 5.8%; P = .001) and overall survival (OS) rates (64.0% vs. 43.2%; P < .001). Improvements in liver inflammation and fibrosis were independently associated with better RFS (both P < .001) and OS (P = .013 and P < .001, respectively).

Study details: The study matched 103 adult patients who received AVT after having undergone hepatectomy for HBV-related HCC to an equal number of those who did not receive posthepatectomy AVT.

Disclosures: The study was sponsored by the National Natural Science Foundation of China and Foundation of Zhongshan Hospital. The authors did not declare any conflicts of interest.

Source: Guan R-Y et al. Am J Surg. 2022 (Jan 25). Doi: 10.1016/j.amjsurg.2022.01.008.

Key clinical point: Antiviral therapy (AVT)-mediated reduction in liver inflammation and fibrosis is associated with improvement in the long-term outcomes of patients who have undergone hepatectomy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

Main finding: AVT vs. non-AVT patients exhibited significantly higher 5-year recurrence-free survival (RFS) rates (19.1% vs. 5.8%; P = .001) and overall survival (OS) rates (64.0% vs. 43.2%; P < .001). Improvements in liver inflammation and fibrosis were independently associated with better RFS (both P < .001) and OS (P = .013 and P < .001, respectively).

Study details: The study matched 103 adult patients who received AVT after having undergone hepatectomy for HBV-related HCC to an equal number of those who did not receive posthepatectomy AVT.

Disclosures: The study was sponsored by the National Natural Science Foundation of China and Foundation of Zhongshan Hospital. The authors did not declare any conflicts of interest.

Source: Guan R-Y et al. Am J Surg. 2022 (Jan 25). Doi: 10.1016/j.amjsurg.2022.01.008.

Key clinical point: Antiviral therapy (AVT)-mediated reduction in liver inflammation and fibrosis is associated with improvement in the long-term outcomes of patients who have undergone hepatectomy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

Main finding: AVT vs. non-AVT patients exhibited significantly higher 5-year recurrence-free survival (RFS) rates (19.1% vs. 5.8%; P = .001) and overall survival (OS) rates (64.0% vs. 43.2%; P < .001). Improvements in liver inflammation and fibrosis were independently associated with better RFS (both P < .001) and OS (P = .013 and P < .001, respectively).

Study details: The study matched 103 adult patients who received AVT after having undergone hepatectomy for HBV-related HCC to an equal number of those who did not receive posthepatectomy AVT.

Disclosures: The study was sponsored by the National Natural Science Foundation of China and Foundation of Zhongshan Hospital. The authors did not declare any conflicts of interest.

Source: Guan R-Y et al. Am J Surg. 2022 (Jan 25). Doi: 10.1016/j.amjsurg.2022.01.008.

Key clinical point: H1-antihistamines (AH) may serve as potential adjuvants in preventing hepatocellular carcinoma (HCC) occurrence in patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or dual HBV-HCV infection.

Main finding: AH use vs. nonuse led to a significantly reduced risk of HCC occurrence in patients infected with HBV (adjusted hazard ratio [aHR] 0.489; 95% CI 0.455-0.524), HCV (aHR 0.484; 95% CI 0.450-0.522), and dual HBV-HCV (aHR 0.469; 95% CI 0.416-0.529).

Study details: This was a retrospective cohort study involving adult patients with either HBV (n = 521,071), HCV (n = 169,159), or dual HBV-HCV (n = 39,016) infection, with each of the 3 cohorts including AH users (HBV, n = 127,398; HCV, n = 40,428; dual HBV-HCV, n =      8,661) and an equal number of non-AH users (<28 cumulative defined daily doses) after 1:1 individual matching.

Disclosures: The study was conducted with financial support from the Ministry of Science and Technology of the Republic of China and Taipei Medical University Hospital. The authors did not report any conflicts of interest.

Source: Shen YC et al. J Clin Oncol. 2022 (Jan 19). Doi: 10.1200/JCO.21.01802.

Key clinical point: H1-antihistamines (AH) may serve as potential adjuvants in preventing hepatocellular carcinoma (HCC) occurrence in patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or dual HBV-HCV infection.

Main finding: AH use vs. nonuse led to a significantly reduced risk of HCC occurrence in patients infected with HBV (adjusted hazard ratio [aHR] 0.489; 95% CI 0.455-0.524), HCV (aHR 0.484; 95% CI 0.450-0.522), and dual HBV-HCV (aHR 0.469; 95% CI 0.416-0.529).

Study details: This was a retrospective cohort study involving adult patients with either HBV (n = 521,071), HCV (n = 169,159), or dual HBV-HCV (n = 39,016) infection, with each of the 3 cohorts including AH users (HBV, n = 127,398; HCV, n = 40,428; dual HBV-HCV, n =      8,661) and an equal number of non-AH users (<28 cumulative defined daily doses) after 1:1 individual matching.

Disclosures: The study was conducted with financial support from the Ministry of Science and Technology of the Republic of China and Taipei Medical University Hospital. The authors did not report any conflicts of interest.

Source: Shen YC et al. J Clin Oncol. 2022 (Jan 19). Doi: 10.1200/JCO.21.01802.

Key clinical point: H1-antihistamines (AH) may serve as potential adjuvants in preventing hepatocellular carcinoma (HCC) occurrence in patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or dual HBV-HCV infection.

Main finding: AH use vs. nonuse led to a significantly reduced risk of HCC occurrence in patients infected with HBV (adjusted hazard ratio [aHR] 0.489; 95% CI 0.455-0.524), HCV (aHR 0.484; 95% CI 0.450-0.522), and dual HBV-HCV (aHR 0.469; 95% CI 0.416-0.529).

Study details: This was a retrospective cohort study involving adult patients with either HBV (n = 521,071), HCV (n = 169,159), or dual HBV-HCV (n = 39,016) infection, with each of the 3 cohorts including AH users (HBV, n = 127,398; HCV, n = 40,428; dual HBV-HCV, n =      8,661) and an equal number of non-AH users (<28 cumulative defined daily doses) after 1:1 individual matching.

Disclosures: The study was conducted with financial support from the Ministry of Science and Technology of the Republic of China and Taipei Medical University Hospital. The authors did not report any conflicts of interest.

Source: Shen YC et al. J Clin Oncol. 2022 (Jan 19). Doi: 10.1200/JCO.21.01802.

Key clinical point: Given its efficacy and safety as first-line therapy for advanced hepatocellular carcinoma (HCC), lenvatinib may serve as an alternative for patients with advanced
HCC and contraindications to immunotherapies.

Main finding: The median overall survival (12.8 months; 95% CI, 10.9-14.7 months) and progression-free survival (6.4 months; 95% CI, 5.1-7.7 months) achieved by lenvatinib in the real world were comparable with those reported by the phase 3 REFLECT trial (13.6 months and 7.4 months, respectively). Similarly, the percentage of patients showing grade 3 or higher adverse events (47.3%) was equivalent to that in REFLECT (56.7%).

Study details: The findings are derived from a real-world retrospective multicenter study, termed ELEVATOR, which included 205 patients with advanced HCC and no history of prior systemic therapy  and who received first-line therapy with lenvatinib.

Disclosures: The study was sponsored by Eisai. Some of the authors declared receiving speaker/advisor/consultant honoraria from various pharmaceutical companies including Eisai.

Source: Welland S et al. Liver Cancer. 2022 (Jan 14). Doi: 10.1159/000521746.

Key clinical point: Given its efficacy and safety as first-line therapy for advanced hepatocellular carcinoma (HCC), lenvatinib may serve as an alternative for patients with advanced
HCC and contraindications to immunotherapies.

Main finding: The median overall survival (12.8 months; 95% CI, 10.9-14.7 months) and progression-free survival (6.4 months; 95% CI, 5.1-7.7 months) achieved by lenvatinib in the real world were comparable with those reported by the phase 3 REFLECT trial (13.6 months and 7.4 months, respectively). Similarly, the percentage of patients showing grade 3 or higher adverse events (47.3%) was equivalent to that in REFLECT (56.7%).

Study details: The findings are derived from a real-world retrospective multicenter study, termed ELEVATOR, which included 205 patients with advanced HCC and no history of prior systemic therapy  and who received first-line therapy with lenvatinib.

Disclosures: The study was sponsored by Eisai. Some of the authors declared receiving speaker/advisor/consultant honoraria from various pharmaceutical companies including Eisai.

Source: Welland S et al. Liver Cancer. 2022 (Jan 14). Doi: 10.1159/000521746.

Key clinical point: Given its efficacy and safety as first-line therapy for advanced hepatocellular carcinoma (HCC), lenvatinib may serve as an alternative for patients with advanced
HCC and contraindications to immunotherapies.

Main finding: The median overall survival (12.8 months; 95% CI, 10.9-14.7 months) and progression-free survival (6.4 months; 95% CI, 5.1-7.7 months) achieved by lenvatinib in the real world were comparable with those reported by the phase 3 REFLECT trial (13.6 months and 7.4 months, respectively). Similarly, the percentage of patients showing grade 3 or higher adverse events (47.3%) was equivalent to that in REFLECT (56.7%).

Study details: The findings are derived from a real-world retrospective multicenter study, termed ELEVATOR, which included 205 patients with advanced HCC and no history of prior systemic therapy  and who received first-line therapy with lenvatinib.

Disclosures: The study was sponsored by Eisai. Some of the authors declared receiving speaker/advisor/consultant honoraria from various pharmaceutical companies including Eisai.

Source: Welland S et al. Liver Cancer. 2022 (Jan 14). Doi: 10.1159/000521746.

Key clinical point: Although using the triple biomarkers alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP) in combination in the GALAD score is associated with increased sensitivity of hepatocellular carcinoma (HCC) diagnosis, the corresponding increase in false-positive results negates the advantage.

Main finding: Within 6, 12, and 24 months of HCC diagnosis, GALAD showed the highest true positive rate (TPR; 63.6%, 73.8%, and 71.4%, respectively) but a false positive rate (FPR) of 21.5%-22.9%; at a fixed 10% FPR, the TPR decreased (42.4%-46.9%), making the performance similar to that of AFP-L3 alone.

Study details: The findings are from a prospective cohort, phase 3 biomarker study including 534 patients with cirrhosis, but without present or past HCC, undergoing biannual HCC surveillance with liver imaging (ultrasound, computed tomography, or magnetic resonance imaging) and serum AFP. Of these patients, 50 progressed to develop HCC.

Disclosures: The study was sponsored by US National Institutes of
Health-National Cancer Institute, US National Institute of Diabetes and Digestive and Kidney Diseases, and Wako Inc. The authors declared having no conflicts of interest.

Source: Tayob N et al. Clin Gastroenterol Hepatol. 2022 (Feb 2). Doi: 10.1016/j.cgh.2022.01.047.

Key clinical point: Although using the triple biomarkers alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP) in combination in the GALAD score is associated with increased sensitivity of hepatocellular carcinoma (HCC) diagnosis, the corresponding increase in false-positive results negates the advantage.

Main finding: Within 6, 12, and 24 months of HCC diagnosis, GALAD showed the highest true positive rate (TPR; 63.6%, 73.8%, and 71.4%, respectively) but a false positive rate (FPR) of 21.5%-22.9%; at a fixed 10% FPR, the TPR decreased (42.4%-46.9%), making the performance similar to that of AFP-L3 alone.

Study details: The findings are from a prospective cohort, phase 3 biomarker study including 534 patients with cirrhosis, but without present or past HCC, undergoing biannual HCC surveillance with liver imaging (ultrasound, computed tomography, or magnetic resonance imaging) and serum AFP. Of these patients, 50 progressed to develop HCC.

Disclosures: The study was sponsored by US National Institutes of
Health-National Cancer Institute, US National Institute of Diabetes and Digestive and Kidney Diseases, and Wako Inc. The authors declared having no conflicts of interest.

Source: Tayob N et al. Clin Gastroenterol Hepatol. 2022 (Feb 2). Doi: 10.1016/j.cgh.2022.01.047.

Key clinical point: Although using the triple biomarkers alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP) in combination in the GALAD score is associated with increased sensitivity of hepatocellular carcinoma (HCC) diagnosis, the corresponding increase in false-positive results negates the advantage.

Main finding: Within 6, 12, and 24 months of HCC diagnosis, GALAD showed the highest true positive rate (TPR; 63.6%, 73.8%, and 71.4%, respectively) but a false positive rate (FPR) of 21.5%-22.9%; at a fixed 10% FPR, the TPR decreased (42.4%-46.9%), making the performance similar to that of AFP-L3 alone.

Study details: The findings are from a prospective cohort, phase 3 biomarker study including 534 patients with cirrhosis, but without present or past HCC, undergoing biannual HCC surveillance with liver imaging (ultrasound, computed tomography, or magnetic resonance imaging) and serum AFP. Of these patients, 50 progressed to develop HCC.

Disclosures: The study was sponsored by US National Institutes of
Health-National Cancer Institute, US National Institute of Diabetes and Digestive and Kidney Diseases, and Wako Inc. The authors declared having no conflicts of interest.

Source: Tayob N et al. Clin Gastroenterol Hepatol. 2022 (Feb 2). Doi: 10.1016/j.cgh.2022.01.047.

Key clinical point: Perioperative programmed cell death protein 1 blockade via neoadjuvant cemiplimab monotherapy may offer survival benefit in patients with resectable hepatocellular carcinoma (HCC) without compromising on safety.

Main finding: Significant (>70%) tumor necrosis was observed in 20% of patients who underwent successful resection, of which 15% showed complete (100%) tumor necrosis. Grade 3 adverse events were observed in 33% of patients, whereas no grade 4/5 adverse events were noted.

Study details: The preliminary data are derived from a single-center phase 2 trial involving 21 adult patients with resectable HCC who received 2 doses of cemiplimab followed by surgical resection.

Disclosures: This study was sponsored by Regeneron Pharmaceuticals. Some of the authors, including the lead author, declared receiving research funds from or serving as an employee and shareholder, consultant, or advisor for various organizations including Regeneron Pharmaceuticals.

Source: Marron TU et al. Lancet Gastroenterol Hepatol. 2022;7(3):P219-29 (Jan 19). Doi: 10.1016/S2468-1253(21)00385-X.

Key clinical point: Perioperative programmed cell death protein 1 blockade via neoadjuvant cemiplimab monotherapy may offer survival benefit in patients with resectable hepatocellular carcinoma (HCC) without compromising on safety.

Main finding: Significant (>70%) tumor necrosis was observed in 20% of patients who underwent successful resection, of which 15% showed complete (100%) tumor necrosis. Grade 3 adverse events were observed in 33% of patients, whereas no grade 4/5 adverse events were noted.

Study details: The preliminary data are derived from a single-center phase 2 trial involving 21 adult patients with resectable HCC who received 2 doses of cemiplimab followed by surgical resection.

Disclosures: This study was sponsored by Regeneron Pharmaceuticals. Some of the authors, including the lead author, declared receiving research funds from or serving as an employee and shareholder, consultant, or advisor for various organizations including Regeneron Pharmaceuticals.

Source: Marron TU et al. Lancet Gastroenterol Hepatol. 2022;7(3):P219-29 (Jan 19). Doi: 10.1016/S2468-1253(21)00385-X.

Key clinical point: Perioperative programmed cell death protein 1 blockade via neoadjuvant cemiplimab monotherapy may offer survival benefit in patients with resectable hepatocellular carcinoma (HCC) without compromising on safety.

Main finding: Significant (>70%) tumor necrosis was observed in 20% of patients who underwent successful resection, of which 15% showed complete (100%) tumor necrosis. Grade 3 adverse events were observed in 33% of patients, whereas no grade 4/5 adverse events were noted.

Study details: The preliminary data are derived from a single-center phase 2 trial involving 21 adult patients with resectable HCC who received 2 doses of cemiplimab followed by surgical resection.

Disclosures: This study was sponsored by Regeneron Pharmaceuticals. Some of the authors, including the lead author, declared receiving research funds from or serving as an employee and shareholder, consultant, or advisor for various organizations including Regeneron Pharmaceuticals.

Source: Marron TU et al. Lancet Gastroenterol Hepatol. 2022;7(3):P219-29 (Jan 19). Doi: 10.1016/S2468-1253(21)00385-X.