Liver cancer systemic treatment patterns in the largely rural state of New Mexico.

Abstract

e18166 Background: New Mexico (NM) has one of the highest rates for hepatocellular carcinoma (HCC) in the US. Systemic therapy (ST) for HCC is typically reserved for patients with unresectable or metastatic disease. Sorafenib has been commonly used as the first-line (1L) systemic agent for HCC after its FDA-approval in 2007. Since 2017, several other agents have been FDA-approved for HCC including lenvatinib as 1L therapy and regorafenib, cabozantinib, ramucirumab and checkpoint inhibitors (nivolumab and pembrolizumab) as second-line (2L) treatment options. This retrospective study describes the HCC treatment patterns of patients seen at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Following approval by the institutional review board, a retrospective chart review of all consecutive HCC patients at the UNMCCC between January 1, 2012 and August 30, 2018 was performed. Patients were identified accessing the UNMCCC tumor registry database. Data on patients’ characteristics, treatments and outcomes were collected. Descriptive statistics were conducted for this initial analysis. Results: A total of 99 of the 380 patients seen at the UNMCCC within the study period were considered for systemic therapy. Most patients were males (82.8%) and of Hispanic/Latino (57.6%) ethnicity. The majority of patients had one or more risk factors for HCC including a history of hepatitis (70.7%), cirrhosis (70.7%), and history of alcohol use (72.7%). Child Pugh class A and B were seen in 30.3% and 44.4% of patients, respectively. Ninety-six patients were prescribed sorafenib initially; however, only 67 patients (70%) successfully initiated treatment. The median time between sorafenib prescription and treatment initiation was 15 days. Only fifty percent of patients started sorafenib with the FDA-recommended dose of 400mg PO BID. Commonly reported adverse events were fatigue, diarrhea, hand and foot syndrome and LFT elevation. After 2017, when 2L options became available, 11 of 27 patients that started on sorafenib continued on to 2L (9 patients received nivolumab and 2 patients received regorafenib). Outcome data are currently being analyzed and will be reported. Conclusions: Although systemic options are available for the treatment of HCC, a significant number of patients are still not accessing and receiving treatment. A detailed analysis of factors affecting treatment patterns in New Mexico is warranted.