# Clinical Characteristics of Patients With Advanced Hepatocellular Carcinoma Who Transitioned to Subsequent Therapies Following Systemic Therapy

## TL;DR

This study identifies factors that help patients with advanced liver cancer move to additional treatments after first-line therapy.

## Contribution

The study identifies clinical factors associated with transitioning to subsequent therapies in advanced hepatocellular carcinoma patients.

## Key findings

- Patients with better ALBI scores, earlier TNM stages, and ICI treatment were more likely to transition to subsequent therapies.
- Initiating systemic therapy before progression and preserving liver function improves chances of further treatment.
- ALBI score, ICI use, and TNM stage were significant predictors of transitioning to second-line therapies.

## Abstract

This study aimed to clarify the clinical characteristics of patients with advanced hepatocellular carcinoma (HCC) who transitioned to subsequent therapies following systemic therapy (ST).

In total, 136 patients with unresectable HCC (26 hepatitis B, 47 hepatitis C and 63 others) receiving first‐line ST, including 31 patients treated with immune checkpoint inhibitors (ICIs), were enrolled. Clinical characteristics and adverse events observed during treatment, as well as overall survival (OS), progression‐free survival and post progression survival (PPS), were compared between patients who transitioned to subsequent therapies (2nd therapy group, n = 66) and those who did not (non‐2nd therapy group, n = 70).

Significant differences between the two groups were observed in OS (29.3 vs. 10.7 months, p < 0.001), PPS (11.3 vs. 2.9 months, p < 0.001), ALBI score (−2.48 vs. −2.34, p = 0.018), treatment with/without ICIs (24/42 vs. 7/63, p < 0.001), TNM stage (II/III/IVA/IVB; 15/26/7/18 vs. 3/27/10/30, p = 0.008) and the adverse events of appetite loss (p = 0.009) and proteinuria (p = 0.006). A favourable ALBI score (p = 0.005), treatment with ICIs (p = 0.002) and earlier TNM stage (p = 0.027) identified by logistic regression analysis and TNM stage II in men and prothrombin time ≥ 105% in women by classification tree analysis were found to be associated with a higher likelihood of transitioning to subsequent therapies.

Initiating systemic therapy, including ICIs, before clinical stage progression and preserving the hepatic reserve is crucial for ensuring a smooth transition to subsequent therapies.

N/A.

Among 136 patients with hepatocellular carcinoma (HCC) receiving first‐line systemic therapy (ST), 66 successfully transitioned to subsequent therapies. favourable ALBI scores, earlier TNM stage at the initiation of ST and treatment with immune checkpoint inhibitors (ICIs) were more likely to progress to subsequent therapies. Initiating systemic therapy, including ICIs, before clinical stage progression and preserving the hepatic reserve is crucial for ensuring a smooth transition to subsequent therapies.