Clinical Outcomes By Child-Pugh Class in Patients With Advanced Hepatocellular Carcinoma in a Community Oncology Setting

Abstract

Aim

Many pivotal trials in advanced hepatocellular carcinoma (HCC) require participants to have Child-Pugh A disease. However, many patients in real-world practice are Child-Pugh B or C. This study examined treatment patterns and clinical outcomes in patients with advanced HCC treated with first-line systemic therapy.

Materials & methods

In this retrospective study, patients with HCC treated with first-line systemic therapy (2010–2017) were identified from US Oncology Network records. Outcomes included overall survival and progression-free survival, by Child-Pugh Class and prior liver-directed therapy.

Results

Of 352 patients, 78.7% were Child-Pugh A or B, 96.6% received first-line sorafenib, and 33.8% received first-line-prior liver-directed therapy. Survival outcomes were similar for Child-Pugh A or B, and longer after first-line prior liver-directed therapy.

Conclusion

First-line systemic therapy is beneficial in patients with Child-Pugh A or B, and after first-line prior liver-directed therapy. These findings may help position systemic therapy in the community setting.

Keywords::

• Child-Pugh class
• clinical outcomes
• hepatocellular carcinoma
• real-world evidence
• systemic therapy
• treatment patterns

Author contributions

AA: conception and design of the study; analysis and interpretation of data; administrative, technical, or material support. NF: conception and design of the study; analysis and interpretation of data; administrative, technical, or material support; study supervision. BS: conception and design of the study; analysis and interpretation of data; administrative, technical, or material support; study supervision. TP: data acquisition; analysis and interpretation of data. YW: analysis and interpretation of data. SP: conception and design of the study; analysis and interpretation of data; study supervision. ARH: conception and design of the study; analysis and interpretation of data; study supervision.

Financial & competing interests disclosure

This study was funded by AstraZeneca. A Aly was an employee of and held stock in AstraZeneca at the time of the study, and is an employee of and holds stock in Novo Nordisk. N Fulcher is an employee of McKesson Life Sciences. B Seal was an employee of AstraZeneca at the time of the study and holds stock in AstraZeneca. T Pham was an employee of and a held stock in McKesson Life Sciences at the time of the study, is an employee of and holds stock in Deciphera Pharmaceuticals, and holds stock in MacroGenics. Y Wang is an employee of and holds stock in McKesson Life Sciences. S Paulson reports holding stock in Actinium, Aptose, Alexion Pharmaceuticals, Lyn Health, and Stromatis Pharma; receiving Honoraria from Cardinal Health; a consulting or advisory role for AADi, Advanced Accelerator Applications, Amgen, Astellas Pharma, Bristol Myers Squibb, Eisai, EMD Serono, Exelixis, Incyte, Ipsen, Lilly Pharmaceuticals, Mirati, Hutchinson, Pfizer, QED Therapeutics, and Stromatis Pharma; receiving speakers’ bureau from Ideo Oncology; receiving research funding (to institution) from AstraZeneca, Bayer, Bristol Myers Squibb, Camurus, Deciphera, Exelixis, G1 Therapeutics, Hutchinson, Incyte, Innovative Cellular Therapeutics, Ipsen, Lilly Pharmaceuticals, Merck, Nucana, Relay Therapeutics, Seattle Genetics, Sotio, Taiho Pharmaceutical, Tempus, and Zentalis; and receiving travel expenses from Pfizer. AR He reports no conflicts of interest. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial assistance was provided by E McLachlan and A Briggs on behalf of CMC Connect, a division of IPG Health Medical Communications, and was funded by AstraZeneca in accordance with Good Publication Practice (GPP 2022) guidelines (Ann Intern Med 2022).

Ethical conduct of research

The study protocol was subjected to a privacy review and did not require informed patient consent, because data were deidentified. McKesson received an exemption and waiver of informed consent and authorization from the US Oncology Inc. Institutional Review Board.

Additional information

Funding

This study was funded by AstraZeneca. A Aly was an employee of and held stock in AstraZeneca at the time of the study, and is an employee of and holds stock in Novo Nordisk. N Fulcher is an employee of McKesson Life Sciences. B Seal was an employee of AstraZeneca at the time of the study and holds stock in AstraZeneca. T Pham was an employee of and a held stock in McKesson Life Sciences at the time of the study, is an employee of and holds stock in Deciphera Pharmaceuticals, and holds stock in MacroGenics. Y Wang is an employee of and holds stock in McKesson Life Sciences. S Paulson reports holding stock in Actinium, Aptose, Alexion Pharmaceuticals, Lyn Health, and Stromatis Pharma; receiving Honoraria from Cardinal Health; a consulting or advisory role for AADi, Advanced Accelerator Applications, Amgen, Astellas Pharma, Bristol Myers Squibb, Eisai, EMD Serono, Exelixis, Incyte, Ipsen, Lilly Pharmaceuticals, Mirati, Hutchinson, Pfizer, QED Therapeutics, and Stromatis Pharma; receiving speakers’ bureau from Ideo Oncology; receiving research funding (to institution) from AstraZeneca, Bayer, Bristol Myers Squibb, Camurus, Deciphera, Exelixis, G1 Therapeutics, Hutchinson, Incyte, Innovative Cellular Therapeutics, Ipsen, Lilly Pharmaceuticals, Merck, Nucana, Relay Therapeutics, Seattle Genetics, Sotio, Taiho Pharmaceutical, Tempus, and Zentalis; and receiving travel expenses from Pfizer. AR He reports no conflicts of interest. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.