Changing treatment patterns for hepatocellular carcinoma: A Surveillance, Epidemiology, and End Results-Medicare study.

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.