Changing treatment patterns for hepatocellular carcinoma: A SEER-Medicare study.

e16166 Background: Sorafenib was the first systemic therapy approved in 2005 for hepatocellular carcinoma (HCC), then 9 new therapies were approved between 2017-2022. No studies have evaluated treatment patterns of systemic therapy since these therapies became available. Methods: This retrospective cohort study used SEER-Medicare data to identify patients with a new diagnosis of HCC between 2014-2019 and associated comorbidity and treatment claims through 2020. Patients had continuous coverage with Medicare Parts A/B/D from 3 months before diagnosis to the earlier of 3 years, death or censoring. We excluded deaths reported by death certificate or autopsy. We used claims to identify receipt of local therapies (ablation, transplant, resection, transarterial bland/chemo/radioembolization, external/stereotactic radiation, brachytherapy) and all FDA-approved systemic therapies for HCC. We described cohort characteristics, treatment patterns, and overall survival (OS) and used Chi-squared statistics to compare treatment patterns and OS for patients diagnosed between 2014-17 vs 2018-19. Results: 11,799 patients were included (69.2% male, 76.9% White, median age: 71 years, 36.2% NAFLD, 44.1% Hepatitis C, 10.6% Hepatitis B, 28.1% alcoholic liver disease). Within one year of diagnosis, 76.3% of all patients received any local or systemic treatment, which did not change over time (2014-17: 76.1%, 2018-19: 76.6%, p=0.60). Receipt of local therapy within 1 year was unchanged (2014-17: 73%, 2018-19: 73.2%, p=0.77) and there were no clinically significant changes in treatment rates for specific local therapies. Receipt of systemic therapy in the first year decreased slightly (2014-17: 16.97%, 2018-19: 15.2%, p=0.012). First line systemic treatment changed drastically: 83.7% of patients diagnosed in 2014-17 received first-line sorafenib vs only 40.1% of those diagnosed 2018-19 (Table). Median overall survival for patients receiving no treatment, systemic therapies first or local therapies first was 1.9, 11 and 16.3 months, respectively. Among patients receiving systemic therapy first, survival from initiation of first line treatment increased from 9.1 to 11.2 months for patients diagnosed in 2014-17 vs 2018-19 (p= <.0001). Conclusions: While overall local and systemic treatment rates have not changed substantially, more recent patients with HCC are more likely to receive first-line novel therapies over first-line sorafenib and associated survival has modestly increased. Table: see text