Publications by authors named "Ciro Celsa"

Immune checkpoint inhibitors (ICI) have led to breakthrough improvements in the management of malignancy including hepatocellular (HCC) and biliary tract cancer, improving decades-old standards of care and increasing patient survival. In both liver tumour types, which commonly arise in the context of liver inflammation and underlying functional impairment, the lack of validated predictors of response underscores the need to balance predicted gains in survival with risk of treatment-related hepatoxicity and decompensation of underlying chronic liver disease.In addition, the liver is implicated in the toxicity associated with ICI therapy for non-liver cancers, which exhibits a high degree of variability in presentation and severity.

View Article and Find Full Text PDF
Article Synopsis
  • * A study involving nearly 2,000 non-resectable HCC patients showed that LMWA had comparable safety and overall survival rates to PRFA and significantly better survival rates than TACE after 1, 3, and 5 years.
  • * The results suggest that LMWA is a viable treatment option for early HCC, outperforming TACE while demonstrating similar efficacy to PRFA, which supports its potential inclusion in standardized treatment
View Article and Find Full Text PDF
Article Synopsis
  • This study examines how early clinical hepatic decompensation (CHD) affects the overall survival (OS) of patients with unresectable hepatocellular carcinoma (uHCC) who are receiving systemic treatments like Atezolizumab plus Bevacizumab or Sorafenib.
  • Researchers analyzed data from the IMbrave150 trial and found that patients experiencing early CHD had a significantly higher risk of mortality, indicating a poor prognosis.
  • The study identifies specific factors (like ALBI grade, INR levels, and macrovascular invasion) that put patients at a greater risk for CHD, suggesting that these could be useful in future clinical trials to better assess patient outcomes.
View Article and Find Full Text PDF
Article Synopsis
  • Researchers studied how immune checkpoint inhibitors (ICIs) used before liver surgery can affect tumor regression in patients with hepatocellular carcinoma and their impact on relapse-free survival.* -
  • The analysis involved data from five clinical trials across various countries, focusing on adults with diagnosed liver cancer who had specific health criteria and no previous ICI treatments.* -
  • Out of 111 patients, 104 provided data on tumor response, showing that a significant number (78%) experienced substantial tumor regression, with correlations found between tumor response measurements and relapse-free survival rates.*
View Article and Find Full Text PDF

Introduction: Hepatocellular carcinoma (HCC) presents a formidable challenge in oncology, demanding innovative treatment approaches. Both adjuvant and neoadjuvant therapies, thanks to the introduction of immunotherapy, have emerged as promising strategies in the management of HCC, aiming to reduce the risk of relapse and ultimately to improve survival.

Areas Covered: This review considers current evidence, ongoing clinical trials, and future strategies to elucidate the evolving landscape of neoadjuvant and adjuvant treatments in HCC.

View Article and Find Full Text PDF

Large language models (LLMs) are transforming the medical landscape by enhancing access to information, diagnostics, treatment customization, and medical education, especially in areas like Gastroenterology. LLMs utilize extensive medical data to improve decision-making, leading to better patient outcomes and personalized medicine. These models are instrumental in interpreting medical literature and synthesizing patient data, facilitating real-time knowledge for physicians and supporting educational pursuits in medicine.

View Article and Find Full Text PDF
Article Synopsis
  • * Patients taking metformin had significantly shorter OS (HR 1.9) and PFS (HR 1.6) compared to those not using the medication, while no such differences were found in the Lenvatinib cohort.
  • * The findings suggest a negative impact of metformin usage on patient outcomes specifically in the context of Atezolizumab plus Bevacizumab treatment for HCC, highlighting the need for
View Article and Find Full Text PDF

Background And Aims: Patients with overt or occult hepatitis B virus (HBV) infection receiving immunosuppressive treatments have a wide risk of HBV reactivation (HBVr). We performed meta-analysis with decision curve analyses (DCA) to estimate the risk of HBVr in HBsAg-negative anti-HBc-positive patients naïve to nucleos(t)ide analogues (NAs) receiving immunosuppressive treatments.

Approach And Results: Studies were identified through literature search until October 2022.

View Article and Find Full Text PDF

Importance: The recent change in terminology from nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) highlights the link between hepatic steatosis and metabolic dysfunction, taking out the stigmata of alcohol.

Objective: We compared the effects of NAFLD and MAFLD definitions on the risk of overall and cardiovascular (CV) mortality, liver-related events (LRE), nonfatal CV events (CVE), chronic kidney disease (CKD), and extra-hepatic cancers (EHC).

Data Sources And Study Selection: We systematically searched four large electronic databases for cohort studies (published through August 2023) that simultaneously used NAFLD and MAFLD definitions for examining the risk of mortality and adverse CV, renal, or oncological outcomes associated with both definitions.

View Article and Find Full Text PDF

Background And Aims: Unlike other malignancies, hepatic functional reserve competes with tumor progression in determining the risk of mortality from hepatocellular carcinoma (HCC). However, the relative contribution of hepatic decompensation over tumor progression in influencing overall survival (OS) has not been assessed in combination immunotherapy recipients.

Approach And Results: From the AB-real observational study (n = 898), we accrued 571 patients with advanced/unresectable hepatocellular carcinoma, Child-Pugh A class treated with frontline atezolizumab + bevacizumab (AB).

View Article and Find Full Text PDF

Importance: Whether patients with Child-Pugh class B (CP-B) cancer with unresectable hepatocellular carcinoma (uHCC) benefit from active anticancer treatment vs best supportive care (BSC) is debated.

Objective: To evaluate the association of immune checkpoint inhibitor (ICI)-based therapies vs BSC with overall survival (OS) of patients with uHCC and CP-B liver dysfunction.

Design, Setting, And Participants: This retrospective, multicenter, international clinical case series examined data of patients with CP-B with uHCC who were receiving first-line ICI-based regimens from September 2017 to December 2022 whose data were extracted from an international consortium and compared with a cohort of patients with CP-B receiving BSC.

View Article and Find Full Text PDF

Clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease indicates an increased risk of decompensation and death. While invasive methods like hepatic venous-portal gradient measurement is considered the gold standard, non-invasive tests (NITs) have emerged as valuable tools for diagnosing and monitoring CSPH. This review comprehensively explores non-invasive diagnostic modalities for portal hypertension, focusing on NITs in the setting of hepatitis B and hepatitis C virus-related cirrhosis.

View Article and Find Full Text PDF

Background: Atezolizumab + bevacizumab represent the current standard of care for first-line treatment of advanced hepatocellular carcinoma (HCC). However, direct comparison with other combination treatments including immune checkpoint inhibitors (ICI) + tyrosine kinase inhibitors (TKIs) are lacking.

Objectives: This network meta-analysis (NMA) aims to indirectly compare the efficacy and the safety of first-line systemic therapies for unresectable advanced HCC.

View Article and Find Full Text PDF
Article Synopsis
  • - The study investigated the safety and effectiveness of combining transarterial chemoembolization (TACE) with pembrolizumab in patients with liver-confined hepatocellular carcinoma (HCC), aiming to enhance immunotherapy results and boost adaptive immunity.
  • - Among 15 patients, most experienced treatment-related side effects like skin rash and fatigue, but there were no significant toxicity issues from combining therapies; notable results included a 53% objective response rate and a median overall survival of 33.5 months following treatment.
  • - The research findings suggest that the combination of TACE and pembrolizumab is tolerable and may have a synergistic effect in treating HCC, warranting further exploration of immunotherapy in conjunction with TACE
View Article and Find Full Text PDF
Article Synopsis
  • Hepatocellular carcinoma (HCC) is a major cancer with variable outcomes influenced by tumor size and chronic liver disease severity, complicating patient treatment.
  • Randomized-controlled trials are crucial for unbiased treatment effect estimates in medicine, particularly oncology, while observational studies can suffer from validity issues but may uncover rare or long-term adverse events.
  • The review discusses how to effectively use real-world data and evidence from patient care to tackle unresolved issues in HCC research, comparing the strengths and weaknesses of different study designs.
View Article and Find Full Text PDF
Article Synopsis
  • Immune-related liver injury (irLI) occurs more frequently in patients with hepatocellular carcinoma (HCC) treated with immune checkpoint inhibitors (ICIs) compared to those with other solid tumors, showing an incidence of 11.4% versus 2.6%.
  • Patients with HCC experienced irLI earlier (median of 1.4 months) than those with other cancers (median of 4.7 months), but had higher rates of irLI resolution (72.1% vs. 58.3%).
  • The study suggests that while irLI leads to improved overall survival in HCC patients with milder cases, it also results in lower need for corticosteroids, indicating a different response pattern compared to
View Article and Find Full Text PDF

Systemic treatment for advanced hepatocellular carcinoma (HCC) has been revolutionized over the last few years following the approval of immune checkpoint inhibitors (ICI). Despite the promising survival extension seen with ICI combination regimens, responses are not universally seen and the optimal partner for programmed cell death 1 pathway inhibitors remains to be identified. Even fewer encouraging results have been demonstrated with ICI used for monotherapy.

View Article and Find Full Text PDF

Background & Aims: Alcohol abuse and metabolic disorders are leading causes of hepatocellular carcinoma (HCC) worldwide. Alcohol-related aetiology is associated with a worse prognosis compared with viral agents, because of the lower percentage of patients diagnosed with HCC under routine surveillance and a higher burden of comorbidity in alcohol abusers. This study aimed to describe the evolving clinical scenario of alcohol-related HCC over 15 years (2006-2020) in Italy.

View Article and Find Full Text PDF

Advances in the surgical and systemic therapeutic landscape of hepatocellular carcinoma have increased the complexity of patient management. A dynamic adaptation of the available staging-based algorithms is required to allow flexible therapeutic allocation. In particular, real-world hepatocellular carcinoma management increasingly relies on factors independent of oncological staging, including patients' frailty, comorbid burden, critical tumour location, multiple liver functional parameters, and specific technical contraindications impacting the delivery of treatment and resource availability.

View Article and Find Full Text PDF

Introduction: Hepatic encephalopathy (HE) affects the survival and quality of life of patients with cirrhosis. However, longitudinal data on the clinical course after hospitalization for HE are lacking. The aim was to estimate mortality and risk for hospital readmission of cirrhotic patients hospitalized for HE.

View Article and Find Full Text PDF