# Patient Characteristics, Treatment Patterns, and Outcomes in Unresectable Hepatocellular Carcinoma Treated with First-Line Systemic Therapy in the United States

## TL;DR

This study examines treatment patterns and outcomes for patients with unresectable liver cancer in the U.S., finding that those at higher risk for gastrointestinal bleeding have lower survival rates.

## Contribution

The study introduces a framework for assessing GI bleeding risk and highlights treatment decisions based on patient characteristics in unresectable hepatocellular carcinoma.

## Key findings

- Atezolizumab plus bevacizumab was the most common first-line therapy for unresectable hepatocellular carcinoma patients, regardless of GI bleeding risk.
- Patients with GI bleeding risk had lower overall survival rates compared to those without GI bleeding risk.
- Post-index GI bleeding occurred in 19.4% of patients with GI bleeding risk versus 5.9% without.

## Abstract

This study offers an alternative framework for the assessment of gastrointestinal (GI) bleeding risk in patients with unresectable hepatocellular carcinoma (uHCC). Approximately two-thirds of the patients in this study had GI bleeding risk, and overall survival rates were lower in patients with versus without GI bleeding risk, highlighting the complexity of uHCC and the unmet need for guidance on characteristics-driven treatment decisions.

Background: Immunotherapy-based regimens have expanded the treatment landscape for unresectable hepatocellular carcinoma (uHCC); however, real-world data are limited. Methods: This retrospective, observational study used data from electronic medical records from Mayo Clinic sites across the United States. Patients with uHCC who initiated a first-line (1L) systemic therapy between June 2020–October 2022 with ≥2 follow-up visits were included. Treatment patterns, overall survival (OS), and post-index gastrointestinal (GI) bleeding were assessed by GI bleeding risk defined by Child–Pugh Class B or C, pre-index GI bleeding, uncontrolled hypertension, or significant varices and band ligation. Results: Of 186 included patients, 68.8% had GI bleeding risk and 31.2% did not. Atezolizumab plus bevacizumab was the most common 1L systemic therapy in patients with or without GI bleeding risk (72.7% and 29.3%, respectively). Median OS (95% confidence interval) with atezolizumab plus bevacizumab was 12.8 (8.0–19.3) months and not reached in patients with and without GI bleeding risk, respectively. OS rates with atezolizumab plus bevacizumab in patients with or without GI bleeding risk, respectively, were 52.3% and 70.6% at 12 months, 41.6% and 57.8% at 18 months, and 34.6% and 51.3% at 24 months. Post-index GI bleeding with atezolizumab plus bevacizumab occurred in 19.4% and 5.9% of patients with and without GI bleeding risk, respectively. Conclusions: During this study period, atezolizumab + bevacizumab was the most common 1L therapy for patients with uHCC, regardless of GI bleeding risk. OS rates with atezolizumab + bevacizumab were lower in patients with versus without GI bleeding risk. Findings highlight the unmet need for guidance on characteristics-driven treatment decisions.