The use of oral chemotherapy for un-resectable hepatocellular carcinoma treated at a tertiary care center

Document Type

Conference Proceeding

Publication Date

10-1-2021

Publication Title

Hepatology

Abstract

Background: Sorafenib has long been the gold standard for the treatment of unresectable Hepatocellular Carcinoma (HCC). More recently, novel oral chemotherapy agents have shown to be non-inferior in treatment of HCC. However, limited real world data exist regarding their use in advanced HCC. We assessed the efficacy and safety of Sorafenib, Lenvatinib, and Azetolizumab+ Bevacizumab at a diverse, urban, tertiary center clinical setting. Methods: All patients with advanced HCC treated with Sorafenib, Levatinib and Atezolizumab+Bevacizumab from September 2013 to December of 2020 were assessed. Background information collected including age, gender, race, MELD, Childs Pugh Score, ECOG and Charlson Comorbidity Score. Primary outcomes were overall survival (OS) and progression free survival (PFS). Secondary outcomes included safety and tolerability profiles. Results: A total of 42 patients were included in this analysis. In the Sorafenib treatment group, progression free survival was 12 months on average (median 7) while overall survival was 22 months (median 16.5). 100% of this group had ECOG performance scores of 0-1 and 85% of patients were Child Pugh Class A. In the Azetolizumab+Bevacizumab treatment group, progression free survival was 7.1 months and overall survival was 7.5 months. 89% of this group had ECOG performance scores of 0-1 and were Child Pugh Class A Finally, in the Lenvatinib treatment group, progression free survival and overall survival were 9 and 13.2 months, respectively. 100% of this group had ECOG performance scores of 0-1 and 84% of patients were Child Pugh Class A. Conclusion: Systemic chemotherapy for the treatment of unresectable HCC was safe and effective in this cohort of patients. Rates of overall survival and progression free survival were lower for patients treated with Levatinib and Atezolizumab+Bevacizumab compared to Sorafenib. In our population, Sorafenib remains the optimal treatment method based on our findings of a higher progression free survival and overall survival. In a randomized controlled trial studying sorafenib in HCC treatment, overall survival showed a median of 9.2 months and progression free survival of 5.5 months. Progression free survival was proven to show non-inferiority in our population. We acknowledge that overall survival is favorable in the sorafinib group which was attributed to longer tracking times. Many of the patients in the other arms remain undergoing treatment currently and overall survivability remains a dynamic variable in our ongoing review. In the future, a larger sample size will also provide more information on PFS and OSS.

PubMed ID

Not assigned.

Volume

74

Issue

SUPPL 1

First Page

676A

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