Retrospective SEER-Medicare study of recent changes in treatment patterns for hepatocellular carcinoma

From 2007 to 2017, sorafenib was the sole systemic therapy for hepatocellular carcinoma (HCC), but recently nine new therapies were approved. A retrospective cohort study used SEER-Medicare data to identify patients who had HCC newly diagnosed between 2014 and 2019, with follow-up through 2020. Among 11,766 patients, 60.5% received treatment within 1 year, which remained stable over time (60.4% in 2014-2017 versus 61.0% in 2018-2019; p=0.84). The use of local therapy also remained stable (52.1% versus 52.8%; p=0.43), whereas use of systemic therapy slightly decreased (17.0% versus 15.2%; p=0.01). Introduction of new first-line therapies resulted in decrease of sorafenib use from 84.5% to 41.3%. The median overall survival among patients who received no treatment was 2.2 months, compared with 12.0 months among patients receiving systemic therapy first and 23.6 months among patients receiving local therapy first. Patients who were diagnosed in 2019 had better OS (HR 0.80; 95% CI 0,74-0.86) as did those who received systemic therapy first (0.33; 0.18-0.61) but survival was worse for those who received local therapy first (1.14; 1.08-1.14) compared with those who were diagnosed in 2014. The authors conclude that local therapy patterns remained stable, but novel therapies replaced sorafenib as the preferred first-line treatment, improving survival.