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Updated: Jun 7, 2025
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Changing treatment patterns for hepatocellular carcinoma: A Surveillance, Epidemiology, and End Results-Medicare
Franklin Iheanacho1, Angela C Tramontano1, Thomas Adam Abrams1,2
1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Background:
From 2007 to 2017, sorafenib was the sole systemic therapy for hepatocellular carcinoma (HCC), but nine new therapies were approved from 2017 to 2022. No studies have yet examined population-level treatment patterns for HCC since these approvals.
Methods:
For this retrospective cohort, Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to identify patients who had HCC diagnosed between 2014 and 2019 with claims through 2020. The authors examined patient characteristics, comorbidities, and receipt of local (e.g., transplantation, resection, embolization) and systemic (e.g., sorafenib, lenvatinib, atezolizumab plus bevacizumab) therapies. Cohort characteristics, treatment patterns, and overall survival (OS) were analyzed, and χ2 tests and t-tests were used to compare treatments between the 2014-2017 and 2018-209 cohorts. Adjusted Cox models were used to compare median OS between treatment groups.
Results:
Among 11,766 patients (men, 69.2%; White, 76.9%; median age, 71 years), 60.5% received treatment within 1 year, which remained stable over time (2014-2017, 60.4%; 2018-2019, 61.0%; p = .84). The use of local therapy also remained stable (2014-2017, 52.1%; 2018-2019, 52.8%; p = .43), whereas the use of systemic therapy slightly decreased (2014-2017, 17.0%; 2018-2019, 15.2%; p = .01). First-line systemic treatments shifted significantly, with sorafenib use dropping from 84.5% (2014-2017) to 41.3% (2018-2019). The median OS among patients who received no treatment, systemic therapies first, or local therapies first was 2.2, 12.0, and 23.6 months, respectively. Patients who were diagnosed in 2019 had better OS (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.74-0.86) as did those who received systemic therapy first (HR, 0.33; 95% CI, 0.18-0.61), but survival was worse for those who received local therapy first (HR, 1.41; 95% CI, 1.08-1.84) compared with those who were diagnosed in 2014.
Conclusions:
Local therapy patterns remained stable, but novel therapies replaced sorafenib as the preferred first-line treatment, improving survival.
Insights
Newer hepatocellular carcinoma (HCC) therapies have replaced sorafenib as first-line treatment, leading to improved survival. Treatment patterns remained stable, but the shift in systemic therapies positively impacted patient outcomes.
Area of Science:
- Hepatobiliary oncology
- Cancer treatment patterns
- Real-world evidence in oncology
Background:
- Sorafenib was the primary systemic therapy for hepatocellular carcinoma (HCC) from 2007 to 2017.
- Nine novel HCC therapies were approved between 2017 and 2022.
- Population-level treatment patterns for HCC post-2017 have not been previously studied.
Purpose of the Study:
- To analyze population-level treatment patterns for HCC in the era of newly approved therapies.
- To compare treatment strategies and overall survival (OS) before and after the influx of new systemic agents.
- To evaluate the impact of treatment shifts on HCC patient outcomes.
Main Methods:
- Retrospective cohort study using SEER-Medicare data (2014-2020).
- Identified HCC patients diagnosed between 2014-2019.
- Analyzed patient characteristics, comorbidities, and receipt of local and systemic therapies, comparing 2014-2017 and 2018-2019 cohorts.
Main Results:
- Treatment receipt and local therapy use remained stable between cohorts (approx. 60.5% and 52.5%, respectively).
- Systemic therapy use slightly decreased (17.0% to 15.2%), but first-line treatments shifted significantly from sorafenib (84.5% to 41.3%).
- Median OS was 2.2 months (no treatment), 12.0 months (systemic therapy first), and 23.6 months (local therapy first); 2019 diagnoses and systemic therapy initiation improved OS.
Conclusions:
- Local therapy patterns for HCC remained consistent.
- Novel systemic therapies have supplanted sorafenib as preferred first-line treatments for HCC.
- This shift in first-line systemic therapy is associated with improved patient survival.
