Publications by authors named "Iavarone Massimo"
Background & Aims: The combination of atezolizumab and bevacizumab offers a novel approach to immunomodulation, showing efficacy as a primary treatment in advanced hepatocellular carcinoma (HCC). Concerns about graft safety and rejection have limited its exploration in the neoadjuvant setting of liver transplantation (LT). In this study, we investigate the clinical efficacy and the safety profile of pre-transplant administration of atezolizumab and bevacizumab for HCC.
View Article and Find Full Text PDFWe need evidence-based futility thresholds to transplant grade-3 acute on chronic liver failure patients with poor respiratory, haemodynamic, and metabolic parameters.
Lancet Reg Health Eur
February 2025
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.
Introduction: The most frequently used first-line treatment in patients with advanced hepatocellular carcinoma (HCC) is atezolizumab plus bevacizumab. Upon progression after this treatment, the standard of care in many countries is sorafenib, due to the lack of reimbursement for other drugs. Several randomized trials are currently underway to clarify the best second-line therapy in patients with HCC.
View Article and Find Full Text PDFArticle Synopsis
- * A retrospective analysis of 885 HCC patients showed no significant differences in overall survival, time to progression, or disease control rates between viral and nonviral patients treated with the combination therapy.
- * Common prognostic factors were identified across both groups, but there might be some stronger associations between immunological factors and outcomes specifically in viral patients, while treatment-related toxicities and second-line treatments showed nearly identical results for both etiology subgroups.
Chronic liver disease and cancer are global health challenges. The role of the circadian clock as a regulator of liver physiology and disease is well established in rodents, however, the identity and epigenetic regulation of rhythmically expressed genes in human disease is less well studied. Here we unravel the rhythmic transcriptome and epigenome of human hepatocytes using male human liver chimeric mice.
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- * 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
Background: Delays and limitations of palliative care in patients with liver transplantation- end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines.
Aim: To assess physicians' attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists.
Design: Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant- end-stage hepatocellular carcinoma.
Article Synopsis
- The study examines muscle changes, specifically sarcopenia and myosteatosis, in cirrhosis patients to understand their prevalence and impact on health over a year.
- In a group of 433 patients, different combinations of these muscle changes were found, with notable increases in mortality and hospitalization rates linked to isolated myosteatosis and combined muscle changes.
- Findings indicate that both myosteatosis and sarcopenia are common in cirrhosis, leading to worse health outcomes, emphasizing the need for better prognostic evaluations in these patients.
Article Synopsis
- Lenvatinib is a treatment for advanced hepatocellular carcinoma (aHCC), but it can increase the risk of bleeding from esophagogastric varices (EGVs). This study looked into how common EGVs are, what predicts their bleeding, and the complications they cause in patients receiving lenvatinib.
- A total of 535 cirrhotic patients undergoing lenvatinib treatment were examined. The study found that 44% of these patients had EGVs, with a 3% incidence of bleeding over 12 months, mainly occurring in patients identified as being at high risk for EGVs.
- The only notable predictor for EGV bleeding was having high-risk
Article Synopsis
- * The research identified independent prognostic factors affecting overall survival and progression-free survival, notably the severity of decreased appetite, immunotoxicity, diarrhea, fatigue, arterial hypertension, and proteinuria.
- * The findings underscore a significant relationship between the occurrence of AEs and therapy outcomes in HCC patients, similar to what has been observed in other treatment contexts, highlighting the importance of monitoring AEs for prognosis.
Background And Aims: Sarcopenia has been associated with poor outcomes in patients with cirrhosis and hepatocellular carcinoma. We investigated the impact of sarcopenia on survival in patients with advanced hepatocellular carcinoma treated with Sorafenib.
Methods: A total of 328 patients were retrospectively analyzed.
Article Synopsis
- - The study examines the impact of Body Mass Index (BMI) on survival among patients with advanced liver cancer (HCC) undergoing first-line treatment with either atezolizumab plus bevacizumab or lenvatinib, focusing on underweight, normal-weight, and overweight classifications.
- - In a cohort of 1,292 patients, results indicated that underweight individuals had significantly shorter overall survival (OS) compared to normal-weight patients, while no significant differences in OS were observed between normal and overweight patients.
- - The research highlights the differing prognostic implications of BMI in cancer treatment, suggesting that underweight patients may require more focused clinical considerations in advanced HCC therapy.
The outcome of liver transplantation (LT) for hepatocarcinoma (HCC) is strongly influenced by HCC staging, which is based on radiological examinations in a pre-LT setting; concordance between pre-LT radiological and definitive pathological staging remains controversial. To address this issue, we retrospectively analyzed our LT series to assess concordance between radiology and pathology and to explore the factors associated with poor concordance and outcomes. We included all LTs with an HCC diagnosis performed between 2013 and 2018.
View Article and Find Full Text PDFBackground: Data concerning the use of lenvatinib in very old patients (≥ 80 years) are limited, although the incidence of hepatocellular carcinoma (HCC) in this patient population is constantly increasing.
Objective: This analysis aimed to evaluate the efficacy and safety of lenvatinib in a large cohort of very old patients (≥ 80 years) with unresectable HCC.
Patients And Methods: The study was conducted on a cohort of 1325 patients from 46 centers in four Western and Eastern countries (Italy, Germany, Japan, and the Republic of Korea) who were undergoing first-line treatment with lenvatinib between July 2010 and February 2022.
Clinical Impact of a Protocol Involving Cone-Beam CT (CBCT), Fusion Imaging and Ablation Volume Prediction in Percutaneous Image-Guided Microwave Ablation in Patients with Hepatocellular Carcinoma Unsuitable for Standard Ultrasound (US) Guidance.
J Clin Med
December 2023
Purpose: to evaluate the clinical impact of a protocol for the image-guided percutaneous microwave ablation (MWA) of hepatocellular carcinoma (HCC) that includes cone-beam computed tomography (CBCT), fusion imaging and ablation volume prediction in patients with hepatocellular carcinoma unsuitable for standard ultrasound (US) guidance.
Materials And Methods: this study included all patients with HCC treated with MWA between January 2021 and June 2022 in a tertiary institution. Patients were divided into two groups: Group A, treated following the protocol, and Group B, treated with standard ultrasound (US) guidance.
Atezolizumab plus bevacizumab (AB) and lenvatinib can be alternatively used as first-line systemic treatment of unresectable hepatocellular carcinoma (HCC). However, no direct comparison of the two regimens has been performed in randomized clinical trials, making the identification of baseline differential predictors of response of major relevance to tailor the best therapeutic option to each patient. Baseline clinical and laboratory characteristics of real-world AB-treated HCC patients were analyzed in uni- and multivariate analyses to find potential prognostic factors of overall survival (OS).
View Article and Find Full Text PDFDue to the lack of biomarkers predictive of response to atezolizumab-bevacizumab, the standard of care for advanced HCC, we analyzed baseline and early on-treatment variation of peripheral lymphocyte populations of 37 prospective patients treated by atezolizumab-bevacizumab and in 15 prospective patients treated by sorafenib or lenvatinib (TKIs). RNAseq analysis followed by RT-PCR validation on patients-derived PBMC was also performed. At first imaging, re-evaluation 13 patients receiving atezolizumab-bevacizumab, showed an objective response, 17 stable disease, while 7 were nonresponders.
View Article and Find Full Text PDFBackground: Clinical benefits of atezolizumab plus bevacizumab (atezolizumab-bevacizumab) are observed only in a subset of patients with hepatocellular carcinoma and the development of biomarkers is needed to improve therapeutic strategies. The atezolizumab-bevacizumab response signature (ABRS), assessed by molecular biology profiling techniques, has been shown to be associated with progression-free survival after treatment initiation. The primary objective of our study was to develop an artificial intelligence (AI) model able to estimate ABRS expression directly from histological slides, and to evaluate if model predictions were associated with progression-free survival.
View Article and Find Full Text PDFBackground & Aims: Comparative assessments of immunogenicity following different COVID-19 vaccines in patients with distinct liver diseases are lacking. SARS-CoV-2-specific T-cell and antibody responses were evaluated longitudinally after one to three vaccine doses, with long-term follow-up for COVID-19-related clinical outcomes.
Methods: A total of 849 participants (355 with cirrhosis, 74 with autoimmune hepatitis [AIH], 36 with vascular liver disease [VLD], 257 liver transplant recipients [LTRs] and 127 healthy controls [HCs]) were recruited from four countries.
Virtual Treatment Zone From Cone Beam CT Commonly Alters Treatment Plan and Identifies Tumor at Risk for Under-Treatment in US or US Fusion-Guided Microwave Ablation of Liver Tumors.
Technol Cancer Res Treat
November 2023
Article Synopsis
- - Tumor ablation is an important cancer treatment that faces challenges like accurately targeting tumors and confirming complete treatment, which can affect outcomes and lead to residual tumors.
- - The study evaluates the use of "Prediction Ablation Volume Software" combined with cone beam computed tomography (CBCT) to enhance the targeting and verification process for liver ablation procedures in a clinical setting.
- - Results from evaluating 29 patients with 32 liver lesions showed high technical success (94%) and technical efficacy (87%), indicating that the software can improve treatment effectiveness and reduce leftover tumor tissue.
Background: Coronary artery disease (CAD) is associated with perioperative liver transplantation (LT) mortality. In absence of a defined risk algorithm, we aimed to test whether stress echocardiography and coronary computed tomography angiography (CCTA) could detect CAD in end-stage liver disease (ESLD) patients without previous evidence of heart disease.
Methods: LT candidates ≥30 years underwent a cardiovascular (CV) assessment through stress echocardiography.