Plasma growth hormone is a potential biomarker of response to atezolizumab and bevacizumab in advanced hepatocellular carcinoma patients

Abstract

// Yehia I. Mohamed 1 , Dan G. Duda 2 , Muhammad O. Awiwi 3 , Sunyoung S. Lee 1 , Lina Altameemi 4 , Lianchun Xiao 5 , Jeffrey S. Morris 6 , Robert A. Wolff 1 , Khaled M. Elsayes 3 , Rikita I. Hatia 7 , Aliya Qayyum 3 , Shadi M. Chamseddine 1 , Asif Rashid 8 , James C. Yao 1 , Armeen Mahvash 9 , Manal M. Hassan 7 , Hesham M. Amin 10 and Ahmed Omar Kaseb 1 1 Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 2 Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA 3 Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 4 Hurley Medical Center, Michigan State University, East Lansing, MI 48824, USA 5 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 6 Department of Biostatistics, Epidemiology, and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA 7 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 8 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA 9 Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX 77030, USA 10 Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA Correspondence to: Ahmed Omar Kaseb, email: [email protected] Keywords: growth hormone; hepatocellular carcinoma; immunotherapy; atezolizumab; bevacizumab Received: September 01, 2022     Accepted: November 23, 2022     Published: December 06, 2022 Copyright: © 2022 Mohamed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ABSTRACT Introduction: Hepatocellular carcinoma (HCC) has limited systemic therapy options when discovered at an advanced stage. Thus, there is a need for accessible and minimally invasive biomarkers of response to guide the selection of patients for treatment. This study investigated the biomarker value of plasma growth hormone (GH) level as a potential biomarker to predict outcome in unresectable HCC patients treated with current standard therapy, atezolizumab plus bevacizumab (Atezo/Bev). Materials and Methods: Study included unresectable HCC patients scheduled to receive Atezo/Bev. Patients were followed to determine progression-free survival (PFS) and overall survival (OS). Plasma GH levels were measured by ELISA and used to stratify the HCC patients into GH-high and GH-low groups (the cutoff normal GH levels in women and men are ≤3.7 μg/L and ≤0.9 μg/L, respectively). Kaplan-Meier method was used to calculate median OS and PFS and Log rank test was used to compare survival outcomes between GH-high and -low groups. Results: Thirty-seven patients were included in this analysis, of whom 31 were males and 6 females, with a median age of 67 years (range: 37–80). At the time of the analysis, the one-year survival rate was 70% (95% CI: 0.51, 0.96) among GH low patients and 33% (95% CI: 0.16, 0.67) among GH high patients. OS was significantly superior in GH-low compared to GH-high patients (median OS: 18.9 vs. 9.3 months; p = 0.014). PFS showed a non-significant trend in favor of GH-low patients compared to the GH-high group (median PFS: 6.6 vs. 2.9 months; p = 0.053). Discussion and conclusions: Plasma GH is a biomarker candidate for predicting treatment outcomes in advanced HCC patients treated with Atezo/Bev. This finding should be further validated in larger randomized clinical trials in advanced HCC patients.

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