Sequential Use of Systemic Therapy With Locoregional Therapy for Hepatocellular Carcinoma in Japan: Analyses of...

The treatment of hepatocellular carcinoma (HCC) in Japan is driven by locoregional therapies (LRTs). However, the treatment landscape in the era of systemic targeted therapies and immunotherapies is not well understood. We investigated the real-world treatment patterns of combined LRT and systemic therapy in Japan.

We performed analyses of the Medical Data Vision (MDV) database using data for patients with a recorded diagnosis of HCC and at least one record of a first LRT (January 1, 2020-December 31, 2022; hepatectomy, transarterial chemoembolization [TACE], radiation therapy [RT], ablation, or hepatic arterial infusion chemotherapy [HAIC]) after the record of HCC diagnosis. We examined the use of preceding systemic therapy (PSysT), maintenance treatment (MT), and next treatments.

Among 15,285 patients, hepatectomy, TACE, RT, ablation, and HAIC were performed in 4506, 6389, 991, 3351, and 48 patients, respectively. Few patients received PSysT, including lenvatinib (by LRT: 0.93%-12.50%) and atezolizumab + bevacizumab (by LRT: 0.29%-4.94%). Only TACE with PSysT increased slightly during the study period. MT was infrequent. Cumulative incidence of next treatment at 6 months varied by type of first LRT, ranging from 6.61% following hepatectomy to 45.06% following HAIC.

LRT alone remained the standard approach for treating HCC in Japan in 2020-2022. The type and duration of therapies used before or after first LRT varied, suggesting a lack of standardized protocols. A clear strategy is needed to evaluate and establish appropriate LRT-based combination therapies for HCC, considering the unmet medical needs identified in this study.