Retrospective cohort study of treatment patterns and survival outcomes among patients with hepatocellular carcinoma

A retrospective cohort study using data from a USA-wide electronic health recored-derived database of more than 280 oncology practices investigated current treatment patterns, sequencing, and survival among patients receiving systemic therapy for hepatocellular carcinoma (HCC) from 2011 through 2023. Among 4198 patients (median age 67 years; IQR 61-74; 79.9% ), 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-lin therapy. Median overall survival was 8.1 months (95% CI 7.7-8.6) but was not significantly associated with first-line systemic therapy type. Median progression-free survival was 3.9 months (95% CI 3.7-4.0); first-line atezolizumab-bevacizumab was associated with improved PFS compared with sorafenib (HR 0.84; 95% CI 0.71-0.99). The authors conclude that atezolizumab-bevacizumab and durvalumab-tremelimumab emerged as most common first-line systemic therapies for HCC, but relatively few patients received second-line therapy.