Real-world use of second-line treatments in patients with advanced hepatocellular carcinoma (HCC) of varying liver dysfunction: Analysis at a Hispanic-majority cancer center.

Abstract

e16676 Background: Hispanics have a higher incidence of HCC but are underrepresented in clinical trials leading to approvals of new therapies for HCC. Further, there is a lack of prospective trials comparing second-line treatments for HCC. Therefore, we reviewed the treatment patterns and tolerability of second-line treatments for HCC at our Hispanic-majority NCI-designated cancer center. Methods: Retrospective analysis of patients with advanced HCC, diagnosed at Mays Cancer Center at UT Health San Antonio from 1/2015-3/2019, who received second-line therapies, including, tyrosine kinase inhibitors (TKIs; Ie, cabozantinib, regorafenib) and immunotherapy (IO; ie, nivolumab), clinical trials, hospice/best supportive care (BSC). Child Pugh cirrhosis and adverse events were be compared. Results: Median age 59 (n = 58), Hispanics n = 43 (74%), Cause of cirrhosis: HCV 42 (74%), HBV 1, EtOH 33, NAFLD/NASH 13. BMI overweight/obese 33 (57%). Child-Pugh: A 9 (16%), B 30 (52%), C 16 (28%) (Table). BCLC B 6 (10%), C 47 (81%). CLIP: 1-2 (16%), 3 (38%), 4+ (41%). Second-line treatments: TKI (4, 7%), IO (24, 41%), Clinical trials (3, 5%), BSC (24, 41%). Toxicities (Table). Dose interruptions or reductions: All 18 (31%), TKIs 3 (75%), IOs (58%), trials (33%). Conclusions: In our Hispanic-majority cohort, 41% of patients with HCC were not candidates for second-line treatments (BSC). Of those who received second-line treatments, most received IOs, including patients with Child-Pugh B and C cirrhosis, with 58% requiring dose interruptions. Only 5% enrolled on clinical trials. Real-world patients are significantly different than clinical trial populations, and we need more prospective real-world analyses of these treatments to better understand efficacy, tolerability and quality of life. [Table: see text]