Survival outcomes among patients with advanced hepatocellular carcinoma (aHCC) treated with systemic therapies.

Abstract

503 Background: HCC is the most common primary liver cancer. Despite the wide use of screening among high-risk individuals, about 45% of cases are diagnosed at the advanced stage. Sorafenib is the only FDA-approved first-line (1L) treatment for aHCC. This study aims to characterize survival by lines of therapy among commercially insured patients with aHCC treated with systemic therapy in the United States. Methods: Adults with ≥ 2 medical claims (30–180 days apart) for primary HCC ( ICD-9 155.0x) from 1/1/2008 to 9/30/2015 were identified in the MarketScan Research Databases. Continuous enrollment was required 6 months before and 1 month after diagnosis. Patients were further categorized into 1L and 2L cohorts if they initiated a targeted therapy, immunotherapy, or chemotherapy. Index date of 1L was the date of the first claim for a systemic agent after diagnosis; index date of 2L was the date of the first claim for a different agent after the end of 1L therapy. Date of death was determined based on records from the linked Social Security Administration Master Death File or on inpatient discharge status. Survival time was measured from the 1L/2L index date to the death date; patients without a death date were censored at end of continuous enrollment or study period, whichever occurred first. Results: 758 patients met the selection criteria for the 1L cohort (mean age, 62.5 ± 10.3 y; 21.9% female); 87 patients (11.5%) went on to receive 2L therapy (mean age, 61.8 ± 9.8 y; 20.7% female). Over half the patients (1L, 54.0%; 2L, 52.9%) died during the follow-up period; median survival time was 205 days (interquartile range [IQR], 290 days) in 1L patients and 280 days (IQR, 232 days) in 2L patients. 32.6% of 1L patients and 34.5% of 2L patients survived ≥ 1 year, and 12.4% of 1L patients and 16.1% of 2L patients survived ≥ 2 years after treatment initiation. Conclusions: Findings suggest that the vast majority of patients with aHCC do not receive 2L therapy. A high 1-year mortality rate represents the lack of effective treatment options in aHCC. Improved therapies are urgently needed for this highly morbid malignancy.