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Purpose: The aim of this study was to investigate the factors predictive of clinical outcome in advanced hepatocellular carcinoma patients receiving ramucirumab treatment. Methods: We conducted a retrospective study using a multi‐institutional electronic medical records database in Taiwan. We included advanced HCC patients newly receiving ramucirumab as second‐line or beyond systemic therapy between January 2016 and February 2022. The clinical outcomes were median progression‐free survival (PFS) based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST), overall survival (OS) and adverse events. We applied Kaplan–Meier methods to estimate median PFS and OS. Uni‐variable and multi‐variable Cox regression models were applied to identify the prognostic factors. Results: We included 39 ramucirumab naive users with a median age of 65.5 (IQR: 57.0–71.0) years and treatment time of 5.0 (3.0–7.0) cycles, of whom 82.1% were male and 84.6% were Barcelona Clinic Liver Cancer (BCLC) stage C. After median follow‐up time of 6.0 months, 33.3% of patients' AFP level had decreased more than 20% within 12 weeks. The median PFS and OS were 4.1 months and non‐reach, respectively. Moreover, tumor burden beyond the up‐to‐11 criteria (HR: 2.95, 95% CI: 1.04–8.38) and a decrease in estimated glomerular filtration rate of more than 10% within 12 weeks (HR: 0.31, 0.11–0.88) were significantly related to PFS in the multi‐variable analysis. No patient discontinued ramucirumab during the treatment on account of side effects. Conclusion: Ramucirumab was an effective treatment option with good AFP response for advanced HCC patients in real‐world experience. Tumor burden beyond the up‐to‐11 criteria and a decrease in estimated glomerular filtration rate were independent predictive factors for progression‐free survival. [ABSTRACT FROM AUTHOR]

Clinical trials have indicated that sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors have a favourable effect on serum alanine aminotransferase (ALT) levels in people with type 2 diabetes (T2D), but supporting evidence from real‐world studies is lacking. We identified patients with T2D who initiated SGLT2 inhibitors during the period 2016 to 2017 from Chang Gung Research Database, which covers 1.3 million individuals from seven hospitals (6% of the Taiwan population). We classified patients by baseline ALT level and evaluated changes in ALT values from baseline to 1 year after initiation of SGLT2 inhibitors. We identified 11 690 new users of SGLT2 inhibitors with a mean (SD) age of 59.3 (11.8) years. The mean (SD) glycated haemoglobin and ALT levels were 8.9 (1.7)% and 34.7 (28.9) U/L at baseline, respectively. The mean change in ALT levels was −5.0 U/L (95% confidence interval [CI] –6.4, −3.5) 1 year after initiation of SGLT2 inhibitors. In patients with ALT levels ≤1× the upper limit of normal (ULN), the change in ALT levels was 1.6 U/L (95% CI –0.1, 3.4), while in those with ALT levels >1× ULN, the change in ALT levels was −26.5 U/L (95% CI –28.6, −24.3). The higher the baseline ALT level, the greater the decline after SGLT2 inhibitor treatment. Our findings suggest the initiation of SGLT2 inhibitors for T2D management could improve serum ALT levels in clinical practice, particularly in patients with especially high ALT levels. [ABSTRACT FROM AUTHOR]