Real-world treatment patterns, clinical outcomes, and health care resource utilization in advanced unresectable hepatocellular carcinoma

Abstract

BACKGROUND: The incidence of advanced unresectable hepatocellular carcinoma (HCC) is increasing in developed countries and the prognosis of advanced HCC remains poor. Real-world evidence of treatment patterns and outcomes can highlight the unmet clinical need. METHODS: We conducted a retrospective population-based cohort study of advanced unresectable HCC patients diagnosed in Alberta, Canada (2008–2018) using electronic medical records and administrative claims data. A chart review was conducted on patients treated with systemic therapy to capture additional information related to treatment. RESULTS: A total of 1,297 advanced HCC patients were included of whom 555 (42.8%) were recurrent cases and the remainder were unresectable at diagnosis. Median age at diagnosis was 64 (range 21–94) years and 82.1% were men. Only 274 patients (21.1%) received first-line systemic therapy and of those, 32 patients (11.7%) initiated second-line therapy. Nearly all of the patients received sorafenib (>96.4%) in first-line, and these patients had considerably higher median survival (12.23 months; 95% CI 10.72–14.10) compared with patients not treated with systemic therapy (2.66 months; 95% CI: 2.33–3.12; log-rank p value <0.001). Among patients treated with systemic therapy, overall survival was higher for recurrent cases, patients with Child-Pugh A functional status, and patients with HCV or multiple known HCC risk factors ( p <0.05). CONCLUSIONS: In a Canadian real-world setting, patients who received systemic therapy had greater survival than those who did not, but outcomes were universally poor. These results underscore the need for effective front-line therapeutic options.

Real-World Treatment Patterns, Clinical Outcomes, Healthcare Resource Utilization, and Costs in Advanced Hepatocellular Carcinoma in Ontario, Canada

“…Our HCRU results for year 1 of the overall cohort were consistently higher than those reported in Alberta [21]: 1.96 versus 1.05 mean inpatient hospitalizations, 2.85 versus 1.82 mean emergency visits, and 11.65 versus 8.96 mean visits with medical oncologists. This could be attributed to varying practice patterns specific to oncology specialists.…”

“…An analysis of 320 HCC patients diagnosed between January 2011 and December 2015 from the Canadian province of Manitoba reported an mOS from diagnosis of approximately 7 months [ 20 ]. Another study examined 1297 advanced unresectable HCC patients in the Canadian province of Alberta and reported an mOS from diagnosis of 12.23 months; however, their patient population included both recurrent and de novo advanced HCC populations [ 21 ]. When examining the mOS of only their de novo population, similar to our study findings, they reported an mOS from diagnosis of less than a year (~10 months) [ 21 ].…”

“…Another study examined 1297 advanced unresectable HCC patients in the Canadian province of Alberta and reported an mOS from diagnosis of 12.23 months; however, their patient population included both recurrent and de novo advanced HCC populations [ 21 ]. When examining the mOS of only their de novo population, similar to our study findings, they reported an mOS from diagnosis of less than a year (~10 months) [ 21 ]. The phase III SHARP trial on sorafenib survival outcomes demonstrated an mOS of 10.7 months for the treatment group.…”

“…Previous studies have demonstrated that evaluating real-world data (RWD) is valuable for analyzing HCC with various applications [ 16 , 20 , 21 ]. ICES data have been used extensively to assess treatment patterns, healthcare resource utilization (HCRU), prevalence, and survival outcomes across multiple tumor areas in Ontario, Canada [ 22 , 23 , 24 , 25 ].…”

“…ICES data have been used extensively to assess treatment patterns, healthcare resource utilization (HCRU), prevalence, and survival outcomes across multiple tumor areas in Ontario, Canada [ 22 , 23 , 24 , 25 ]. Population-level estimates yielded from our analysis may be of great interest for clinicians to enhance the understanding of the clinical outcomes of aHCC patients under the current treatment landscape and for healthcare decision makers, providing them with information about the economic impacts of different therapeutic options [ 21 , 26 , 27 ].…”