Real-world (RW) treatment and surveillance patterns in patients with hepatocellular carcinoma (HCC) after resection (R) or ablation (A): Evidence from commercial and Medicare populations.

Authors

null

Amie Tan

Genentech, South San Francisco, CA

Amie Tan , Robert Schuldt , Sarika Ogale , Sairy Hernandez Painter

Organizations

Genentech, South San Francisco, CA

Research Funding

Pharmaceutical/Biotech Company
Genentech

Background: Prognosis of early HCC after curative resection (R) or ablation (A) remains poor due to lack of approved standard of care for adjuvant therapy. Guidelines recommend that patients (pt) receive surveillance imaging every 3 to 6 months for the first 2 years after R or A. RW data on treatment and surveillance patterns after curative intent therapy in the US can provide insights into how novel therapies may be integrated into the treatment paradigm. Methods: We conducted two retrospective, population-based studies of newly diagnosed HCC pts who underwent R or A as the first HCC therapy using data from Pharmetrics Plus commercial claims (2018 - 2021) and SEER-Medicare data (2010 - 2019), respectively. Continuous enrollment in health plans ≥6 months prior to diagnosis (Dx) date and ≥3 months after R or A, and no transplant during study period, was required. Treatments received within 3 months following R or A were defined as adjuvant therapy. Results: Among 705 eligible HCC pts with commercial insurance coverage, the majority were male (73%) and mean (SD) age at Dx was 61(9) years. Among them, 56% received A, 32% received R, and 12% had both R and A after Dx. 126/705 (18%) pts received adjuvant therapy. Most commonly used treatments were systemic therapy (44%) followed by transarterial chemoembolization (TACE) or transarterial embolization (TAE) (41%). Only 20% of pts received surveillance imaging in the first 2 years following R or A (Table). A total of 2,005 Medicare beneficiaries with HCC were identified from SEER-Medicare (male: 67%; White: 68%; Black: 11%; Asian: 19%). Mean (SD) age at Dx was 70(8) years. Among them, 54% received A, 36% received R, and 10% received both as the initial therapy for HCC. 238/2,005 (12%) pts received adjuvant therapy. Most commonly used treatments were TACE/TAE (61%) followed by systemic therapy (29%). Unlike the commercial insurance cohort, the majority of pts in the Medicare cohort (78%) received surveillance imaging within 2 years following R or A. Conclusions: Despite lack of clinical evidence and approved adjuvant therapy in the US, notable use of treatment in RW practice were observed. Types of adjuvant therapy used and utilization of surveillance varied by payers. A significant proportion of pts did not receive ongoing surveillance imaging despite guideline recommendations. These findings highlight the desire and unmet need for clinical evidence of treatments in pts with early HCC following curative intent therapy.

Commercial Insurance
N=705
SEER-Medicare
N=2,005
Any adjuvant treatment, N (%)126 (18%) 238 (12%)
TACE/TAE, % treated41%61%
SIRT/PEI/TARE, % treated15%10%
Systemic, % treated44%29%
Surveillance imaging within 2 years after R or A, N (%)144 (20%)1,555 (78%)
% by time window (in months)
3-617%45%
6-1227%54%
12-2427%49%

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Hepatobiliary Cancer - Local-Regional Disease

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e16223)

DOI

10.1200/JCO.2023.41.16_suppl.e16223

Abstract #

e16223

Abstract Disclosures

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