SAN ANTONIO—Rising rates of hepatocellular carcinoma (HCC) have focused attention on improving all aspects of the malignancy, from new methods of screening, earlier detection, more efficacious treatment, and extended survival. At the same time, the increased number of cases has made differences in access and outcomes more apparent.
“HCC disparities have been reported across the entirety of the cancer timeline, from screening to local and systemic treatment and liver transplant,” noted researchers at the South Texas Veterans Health Care System in San Antonio, TX, in a presentation at the 2023 American Society of Clinical Oncology in Chicago June 2-6.
The team, led by presenter Lauren Diaz Boyle, DO,, analyzed whether those disparities persisted among veterans with advanced HCC who received first-line treatment with atezolizumab plus bevacizumab (A+B), given the VA’s equal access structure. The researchers tracked patients from initiation of treatment until the earliest of their last VA visit, loss to follow-up, death or study end date of Jan. 23, 2023. Baseline characteristics of patient treatments, follow-up duration, and overall survival were extracted from electronic health records and chart review data.
Of the 325 patients in the study, 64% were non-Hispanic white. Of the 36% in the “all others” group, 26% were Black, 8% Hispanic and 2% were Asian or Indigenous. The average age was 68 years for non-Hispanic whites and 66 years for all others. ECOG performance was less than 1 in 90% of both groups. The etiology of HCC was viral hepatitis for 48% of non-Hispanic whites and 70% of all others.
The analysis showed no significant difference in median time from diagnosis to treatment initiation, number of doses, objective response and disease control rates, overall survival (OS) at six months, progression-free survival (PFS) at six months or one year, or overall survival time. The median time from diagnosis to initiation of treatment was 11 months (2.3-33.5) for non-Hispanic whites and 19.3 months (3.1-34.3) for all others, the median number of doses was five for non-Hispanic whites and six for all others. The objective response rate was 27.4% in non-Hispanic whites and 33.4% in all others, while the disease control rate was virtually identical at 60.1% for non-Hispanic whites and 59.5% for all others.
There was a significant difference in duration of response, which was longer for all others than for non-Hispanic whites, at a median of 11.7 months vs. 8.7 months. Overall survival at one year approached significance, with non-Hispanic whites at 47.3% compared to 58.7% for all others.
“Our VHA real-world data shows that despite having statistically significant etiologies, there was no statistically significant difference in the PFS and OS of patients with advanced HCC receiving first-line A+B in an equal access care system,” the researchers said. “This study supports our group’s findings in other malignant cohorts within VHA where equal healthcare access can mitigate other socio-demographic and biological factors.”
- Boyle LD, Alkadimi M, Fierro ME, Lucero K, Franklin K, Mader M, Nooruddin Z. Evaluating racial disparities for patients with advanced hepatocellular carcinoma (HCC) receiving first line immunotherapy within an equal access system. 2023 ASCO Annual Meeting. June 2-6, 2023. J Clin Oncol 41, 2023 (suppl 16; abstr 4109).
