Liver Cancer and Immunotherapy in the Liquid Biopsy Era

University Hospital, Montpellier60 enrolled

Overview

The goal of this prospective clinical trial is to identify a predictive biomarker in patients with advanced HCC (stage B and C) using a combinatorial approach of the liquid biopsy. The main questions it aims to answer are: * Is multi-omic liquid biopsy approach able to identify a strong predictive biomarker of immunotherapy efficiency? * Is there a correlation between tissue biopsy (PD-L1 tissue level of expression) and liquid biopsy (detection of CTC expressing PD-L1) in HCC patients? Participants blood will be collected at several time points.

In solid cancers, some more aggressive tumor cells actively detach from the primary lesion and then travel through the circulating compartment to reach distant organs and form micro-metastases. Detecting CTCs in the blood is also relevant for assessing tumor progression, prognosis and therapeutic follow-up. The non-invasive, highly sensitive for CTCs analysis is called "liquid biopsy". Over the past few years, a multi-analyses approach (CTCs, circulating tumor DNA, extracellular vesicles, miRNA...) of liquid biopsy has been developed. Hepatocellular carcinoma (HCC) is the predominant pathological type of primary liver cancer. It represents the sixth most common incidence worldwide and the third most common cause of cancer mortality. Since 2021, the gold standard treatment for patients with advanced and/or unresectable HCC is the combination of atezolizumab (anti-PD-L1) and bevacizumab (VEGF inhibitor) in cases where chemoembolization is not indicated (patients with lymph node invasion and/or distant lesions or patients with portal flow abnormality). Indeed, this therapy offers a significant benefit in overall survival (19.2 vs 13.4 months, HR 0.66, p\<0.0009) as well as in progression-free survival (6.9 vs 4.3 months, HR 0.65, p=0.0001). However, to date, there is no predictive biomarker for the efficacy of immune checkpoint inhibitors (ICI) The purpose of this research project is to identify a predictive biomarker in patients with advanced HCC (stage B and C) using a combinatorial approach of the liquid biopsy (CTC, CTC expressing PD-L1, immune cell profiling).

Study Type

INTERVENTIONAL

Allocation

Purpose

OTHER

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients of at least 18 years old, * Patients with advanced hepatocellular carcinoma or HCC with indication for first-line PD-1 or PD-L1 immunotherapy in MDT, without prior systemic therapy, * The diagnosis of HCC is established according to imaging criteria (LI-RADSv2018 criteria) or after histological evidence, * Advanced HCC defined by BCLC stages B and C, * Patients with oral consent. Exclusion Criteria: * Administration of a previous systemic anti-tumor treatment (immunotherapy or chemotherapy or targeted therapy) * No personal history of neoplasia in the previous 5 years * No personal history of systemic inflammatory diseases * No immunosuppressive treatment or treatment that could modify immunity (anti-TNF...) * No affiliation or non-beneficiary of a Social Security system; * Vulnerable persons according to article L1121-6 of the CSP ; * Persons of full age who are protected or unable to give their consent according to article L1121-8 of the CSP; * Pregnant or breastfeeding women according to article L1121-5 of the CSP. * Non-inclusion due to follow-up difficulties (transfer, insufficient motivation, poor compliance, priority associated pathology in care, etc.)

Outcomes

Primary Outcomes

Percentage of patients with CTCs-PD-L1+ by CellSearch® technique

A CTC is being defined as: EpCAM(+)/PanCK(+)/Dapi(+)/CD45(-). The PD-L1 status will be observed only on these cells. CTC-PD-L1- = 0 vs CTC-PD-L1+ ≥1

Time frame: At inclusion

Secondary Outcomes

Number of CTCs-PD-L1+ measured by CellSearch® technique

0 vs. 1 vs. 2-3 vs. 4 vs. ≥5

Time frame: At inclusion

Presence of CTCs at inclusion by CellSearch® technique

Percentage of patients with CTCs

Time frame: At inclusion

Number of CTCs measured by CellSearch® technique

0 vs 1 vs 2-3 vs 4 vs ≥5

Time frame: At inclusion

Immune profiling

FACS study of immune system cells (T cells, NK cells, B cells, macrophages, immune-checkpoint and platelets)

Time frame: 24 month follow up

Expression of PD-L1 by immuno-histochemical analysis of tissue samples

PD-L1 expression on biopsy or surgical specimen previously preserved in the Montpellier University Hospital tumor library

Time frame: At inclusion

Tumor control defined by mRECIST criteria

Best response: complete response + partial response + stable vs progression

Time frame: 24 month follow up

Tumor control defined by RECIST criteria

Best response: complete response + partial response + stable vs progression

Time frame: 24 month follow up

Overall Survival

Time from immunotherapy start date to date of death from any cause

Time frame: 24 month follow-up

Progression Free Survival

Time from immunotherapy start date to date of first progression or date of death from any cause

Time frame: 24 month follow-up

Liver Cancer and Immunotherapy in the Liquid Biopsy Era

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts