Clinical Impact of Serum CRP Levels on Advanced HCC Treated With Durvalumab and Tremelimumab: A Multicentre Study

AIM: This study aimed to evaluate the therapeutic efficacy and prognostic significance of C-reactive protein (CRP) in patients with advanced hepatocellular carcinoma (HCC) receiving durvalumab and tremelimumab (Dur/Tre). METHODS: A total of 167 patients treated with Dur/Tre between March 2023 and March 2024 in Japanese hospitals were included in this retrospective multicentre study. Patients were divided into two groups based on pre-treatment serum CRP levels: the low-CRP group (< 1 mg/dL, n = 106) and the high-CRP group (≥ 1 mg/dL, n = 61). RESULTS: The median age of the cohort was 74.0 years (interquartile range, 67.5-79.5), and 139 patients (83.2%) were male. The median progression-free survival (PFS) was 3.6 months (95% CI: 2.6-5.4) in the low-CRP group and 2.4 months (95% CI: 1.9-4.1) in the high-CRP group, with statistical significance (p = 0.02). The median overall survival (OS) was not reached in the low-CRP group, with a 1-year survival rate of 64.7% (95% CI: 49.0-76.7), while it was 7.9 months (95% CI: 5.8-11.8) in the high-CRP group. The low-CRP group demonstrated significantly better survival outcomes compared to the high-CRP group (p < 0.001). Multivariate analysis identified serum CRP level as an independent predictive factor for both PFS and OS (p = 0.04 and < 0.001, respectively). No significant differences in immune-related adverse events were observed between the two groups. CONCLUSIONS: Serum CRP may serve as a prognostic biomarker in HCC patients receiving Dur/Tre, with a potential association with treatment efficacy.