# Treatment Patterns and Survival Outcomes Among Patients With Hepatocellular Carcinoma

## TL;DR

This study examines how treatment for liver cancer has changed over time and finds that while new therapies are being used more often, few patients receive second-line treatments and survival remains limited.

## Contribution

The study provides real-world data on treatment patterns and outcomes for HCC patients from 2011 to 2023, highlighting the shift from sorafenib to newer combination therapies.

## Key findings

- Atezolizumab-bevacizumab and durvalumab-tremelimumab became the most common first-line therapies for HCC by 2020 and 2023, respectively.
- Only 20.7% of patients received second-line therapy, and median overall survival was 8.1 months regardless of first-line treatment.
- Atezolizumab-bevacizumab was associated with improved progression-free survival compared to sorafenib.

## Abstract

What are the current treatment patterns, sequencing, and survival outcomes among patients receiving systemic therapy for hepatocellular carcinoma (HCC)?

In this cohort study of 4198 patients treated with systemic therapy for HCC between 2011 and 2023, atezolizumab-bevacizumab and durvalumab-tremelimumab replaced sorafenib as the most common first-line therapy over time; only 20% of patients received second-line therapy. Median overall survival was 8.1 months and was not significantly associated with first-line systemic therapy type.

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.

This cohort study evaluates first-line systemic therapies and the need for second-line therapy in patients with hepatocellular carcinoma from 2011 through 2023.

The treatment landscape for hepatocellular carcinoma (HCC) is rapidly evolving, with the approval of multiple systemic therapies for patients with advanced disease since 2017. However, ideal treatment sequencing approaches remain unknown, and data on clinical practice patterns are limited.

To evaluate current treatment patterns, sequencing, and survival outcomes among patients receiving systemic therapy for HCC.

This retrospective cohort study used data from a nationwide electronic health record (EHR)–derived database of more than 280 oncology practices at more than 800 US cancer clinics to assess adult patients who were treated with systemic therapy for HCC from January 1, 2011, to December 31, 2023.

First-line systemic therapy type.

Overall survival (OS) was defined 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 (PFS) was defined as the time from first-line systemic therapy initiation to the earliest of EHR-documented disease progression, death, last clinical encounter, or the censor date.

Among 4198 patients (median [IQR] age, 67 [61-74] years; 3353 [79.9%] male), sorafenib was the most common first-line systemic therapy until it was overtaken by atezolizumab-bevacizumab in 2020; durvalumab-tremelimumab also became a common first-line therapy in 2023. Of the full study cohort, 871 (20.7%) received second-line therapy. Median OS was 8.1 months (95% CI, 7.7-8.6 months) but was not significantly associated with first-line systemic therapy type. Median PFS was 3.9 months (95% CI, 3.7-4.0 months); first-line atezolizumab-bevacizumab (hazard ratio, 0.84; 95% CI, 0.71-0.99) was associated with improved PFS compared with sorafenib.

In this cohort study of patients treated with systemic therapy for HCC between 2011 and 2023, atezolizumab-bevacizumab and durvalumab-tremelimumab emerged as the most common first-line systemic therapies administered for HCC, but relatively few patients received second-line therapy. Additional research is needed to determine optimal treatment sequencing and increase the likelihood that patients may benefit from second-line systemic therapy options.