A recent retrospective cohort study has described the current treatment patterns, sequencing, and survival outcomes among patients receiving systemic therapy for hepatocellular carcinoma (HCC). The findings, which were published by Lau-Min et al in JAMA Network Open, showed that atezolizumab/bevacizumab and durvalumab/tremelimumab-actl were the most common first-line systemic therapies, with second-line treatment infrequently used.
“These results suggest that the [HCC] treatment landscape has evolved considerably during the past decade, but more research is needed to determine optimal treatment sequencing,” the investigators commented.
Study Details
Using data from a nationwide electronic health record–derived database of more than 280 oncology practices at over 800 U.S. cancer clinics, the investigators focused on 4,198 patients (median age = 67 years; male: 79.9%) who were treated with systemic therapy for HCC between January 1, 2011, and December 31, 2023.
The investigators defined overall survival as the time from first-line systemic therapy initiation to death, last clinical activity, or the censor date of December 31, 2023. Progression-free survival was defined as the interval from the initiation of first-line systemic therapy until the earliest of electronic health record–documented disease progression, death, last clinical encounter, or censoring.
Key Findings
Sorafenib remained the most common first-line systemic therapy until 2020, after which atezolizumab/bevacizumab became the most used; durvalumab/tremelimumab gained prominence in 2023. A total of 20.7% of the study cohort received second-line therapy.
The median duration of overall survival was 8.1 months (95% confidence interval [CI] = 7.7–8.6 months); it was not found to be significantly associated with first-line systemic therapy type. The median progression-free survival duration was 3.9 months (95% CI = 3.7–4.0 months); first-line atezolizumab/bevacizumab vs sorafenib appeared to be associated with an improved outcome (hazard ratio = 0.84, 95% CI = 0.71–0.99).
The investigators concluded, “Atezolizumab/bevacizumab and durvalumab/tremelimumab emerged as the most common first-line treatments for [HCC]. Many patients did not receive second-line treatment despite a multitude of available options. Further research, including the use of innovative approaches to combining clinically derived datasets and randomized clinical trials, is needed to determine optimal treatment sequencing as well as strategies to increase the likelihood that patients may benefit from second-line systemic therapy options.”
Kelsey S. Lau-Min, MD, MSCE, of Massachusetts General Hospital, is the corresponding author of the article in JAMA Network Open.
Disclosure: The study was funded by grants from the American Cancer Society and the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
