Racial and ethnic differences in treatment and survival for hepatocellular carcinoma patients undergoing systemic therapy

Abstract Background There are substantial historical racial and ethnic differences in treatment survival for patients with hepatocellular carcinoma (HCC) that may have changed with approval of nine novel systemic HCC therapies between 2017-2022. Methods This retrospective cohort study included patients from the Flatiron Health Research Database who received systemic therapy between 2011-2023. We identified receipt of systemic therapy, including novel systemic therapies receiving FDA approval =2017, and determined overall survival (OS) from start of first-line systemic therapy until death. Multivariable models adjusted for sociodemographic and clinical factors. Results The study included 4,198 patients who were 53.0% White, 11.8% Black, and 5.2% Asian, and 11.2% were Hispanic. Asian patients were more likely than White patients to receive novel systemic therapies (odds ratio OR 1.78, 95% confidence interval CI 1.12–2.83), while Black and Hispanic patients had similar receipt of treatment. Asian and Hispanic patients had median OS of 10.3 and 10.5 months compared to 8.0 and 8.3 months for White and non-Hispanic patients. Asian (HR 0.79, 95% CI 0.65-0.96) and Hispanic patients (HR 0.72, 95% CI 0.62-0.83) had better OS than White and non-Hispanic patients, respectively, which did nots substantially change with stepwise adjustment. Racial differences in survival worsened over time. Receipt of novel therapy was associated with improved survival. Conclusions Asian and Hispanic patients had the best survival and Asian patients were more likely to receive novel therapies. As adjustment for many social and clinical factors had minimal impact on these findings, additional research is needed to understand these survival differences.