995P - Real-world treatment patterns, survival and costs in advanced hepatocellular carcinoma (aHCC) in Ontario, Canada

Background

Our real-world study aimed to assess the current treatment landscape of aHCC in Ontario, Canada.

Methods

This retrospective cohort study used provincial-level databases from Ontario, Canada to identify patients diagnosed with aHCC between April 2010 and March 2019 with follow-up data available until March 2020. De novo stage IV disease and/or receipt of first line (1L) systemic therapy (ST) was used to establish an aHCC diagnosis. Baseline characteristics, treatment patterns, clinical outcomes, health care resource utilization and costs (in 2020 Canadian dollars) were determined.

Results

A total of 7,322 patients were identified using HCC diagnosis codes, of which 802 met the aHCC diagnosis criteria (82% male, median age 66 years). More than half (N=427) received 1L STs (98% sorafenib; <2% lenvatinib), a quarter (N=195) were untreated, and 9% (N=72) were given locoregional therapy without use of ST. Only 4% (N=19) of 1L treated patients were given a 2L treatment. The median time from diagnosis to 1L ST initiation was 2.3 months and median time on 1L ST was 2.4 months. Median overall survival (mOS) from diagnosis was 9.0 months (95% confidence interval [CI]: 7.8-10.3) and 2.7 months (95% CI: 2.3-3.3) for the treated and untreated cohorts, respectively. The mean total cost per 1L treated patient was $49,640, with oral medications as the main cost driver followed by inpatient hospitalizations.

Conclusions

Our study confirmed guarded prognosis of aHCC despite treatments with sorafenib, in keeping with mOS observed in clinical trials. Low uptake of 1L ST and subsequent uptake of 2L underscores high attrition rates likely related to the frailty of aHCC patients and lack of adequate ST options. Future studies will inform whether immunotherapy-based treatments in the latest years will improve ST uptake, attrition rates and health outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

HOPE Research Centre.

Funding

AstraZeneca Canada Inc.

Disclosure

D. Bosse: Financial Interests, Personal, Financially compensated role: Ipsen, AstraZeneca, Bayer, Pfizer, Bristol-Meyers Squibb, Amgen, Merck, Knight Therapeutics, Eisai. Y. Kim, J. Tieu, S.Z. Wang: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks/Shares: AstraZeneca. C. Shephard: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks or ownership: AstraZeneca. All other authors have declared no conflicts of interest.