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Patients With Advanced HCC Often Do Not Receive Second-Line Therapy in Real-World Practice

January 19, 2021


Arjun Gupta, MD, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center (Baltimore, MD), discusses results from a study analyzing real-world treatment patterns and associated outcomes for the second-line treatment of advanced hepatocellular carcinoma (HCC).

These results were presented at the virtual 2021 ASCO Gastrointestinal Cancers Symposium.

Follow Dr Gupta on Twitter: @guptaarjun90


Hi, my name is Arjun Gupta. I'm an oncology fellow at Johns Hopkins. This year, at the ASCO Gastrointestinal Cancer Symposium, we presented an abstract on the contemporary real‑world treatment patterns and outcomes of patients with advanced liver cancer in the United States.

Liver cancer is 1 of the few cancers with a rising global incidence. Many patients, especially those in low and middle‑income countries, are diagnosed an advanced stage of disease. Sorafenib was the only FDA‑approved drug for advanced liver cancer from 2007 to 2017.

Since 2017, there have been a flurry of new drug approvals, both in the first‑line setting and in the second and third‑line settings. This flurry of new drug approvals is exciting, but it's also created confusion for clinicians and patients on how to optimally sequence these therapies.

It's also important to note that patients with advanced liver cancer are often sick. How they tolerate these medications and how they do in the real world may be quite different from how patients and clinical trials did.

For this reason, we took a contemporary cohort of patients with advanced liver cancer in the United States and looked at the treatment patterns of first and second‑line therapy that they received and their treatment outcomes associated with that.

For this analysis, we used the Concerto HealthAI database and included patients diagnosed with advanced liver cancer between 2017 and January of 2020. In this database, eventually, we included almost 600 patients. Notably, only 330 of these almost 600 patients received any therapy. These 330 patients formed the baseline population in our study.

The most commonly used agent first line, as expected, was sorafenib. Of these 330 patients, 207 patients survived 1 month after the end of their first‑line therapy and were labeled as being eligible for a second‑line therapy. Of these 207 patients, only approximately 100 eventually ended up receiving second‑line therapy.

Just to recap, almost 600 patients in the cohort, only approximately 300 get first‑line therapy. Of these, only approximately 200 are alive 1 month after the end of first‑line therapy. Approximately only 100 of these end up getting second‑line therapy. These data point to the fact that patients with advanced liver cancer often do not end up getting second‑line therapy.

The exact reasons of this are unclear from our study, but this could potentially be related to problems with drug access in the United States. It could be related to nihilism, both in the physician community and also in the patient community. It could be that these patients are just too sick, comorbid liver function, other comorbidities. Performance status can often be poorer in these patients.

This may not represent the exact trial populations that are recruited. In essence, this abstract shows that patients with advanced liver cancer in the US, even in the contemporary era, often are unable to receive second‑line therapy. It behooves us to investigate the exact reasons why. It also points to the fact that we should probably be employing our strongest therapy upfront if we're able. Thank you.

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