Racial and ethnical disparities in treatment outcomes in patients with advanced HCC who received first-line immunotherapy.

488 Background: Advancements in immunotherapy (IO) and targeted therapy have shown tremendous improvement in survival outcomes in patients with advanced hepatocellular carcinoma (HCC). Ethnic and racial minorities such as Hispanic and Black are infrequently included in landmark trials despite facing a disproportionate burden of HCC. As such, there is limited real world data on the efficacy of IO in diverse populations, and the mechanisms of treatment disparities among racial cohorts remain unclear. This retrospective study aims to assess clinical outcomes in a racially diverse population of advanced HCC patients treated with first-line IO at a tertiary based academic center in New York City. Methods: Patients with BCLC-C HCC at time of first-line IO at our institution between 2015 and 2024 were included in the study. Demographic data, baseline tumor characteristics, treatment and survival data were collected via electronic medical record review. The primary outcome measures were overall survival (OS), overall response rate (ORR), and progression-free survival (PFS). Kaplan-Meier survival curves were used to assess survival outcomes, and Chi-square tests to compare response rates in different racial groups. Results: A total of 284 patients were included in the analysis (29% Non-Hispanic white, 24% Asian, 20% Hispanic, 16% Black and 10% Others).Analysis of HCC risk factors revealed statistically significant differences in etiology across racial and ethnic groups: with HCV being more common among Black patients (p<0.001) and HBV more common among Asian patients (p<0.001). Cirrhosis was more common among Hispanic patient’s vs Asian (90% vs 64% p<0.001). We found no statistically significant differences in baseline disease characteristics, including portal vein thrombosis, tumor size, number of lesions, presence of extrahepatic spread, and other vascular involvement. The most common first-line IO’s include atezolizumab-bevacizumab (atezo-bev), nivolumab +/- ipilimumab and pembrolizumab. Including all IOs we found no statistically significant differences in OS (p = 0.071) and PFS (p=0.208) across race/ethnicity. In subgroup analysis, among patients who received atezo-bev, the Asian group demonstrated a slightly more favorable median survival, albeit the small sample size. Conclusions: In this diverse real-world cohort of patients with advanced HCC receiving first-line IO, no significant differences were observed in OS or PFS across racial groups, suggesting similar biologic efficacy of IO. The study was limited by its small sample size, retrospective design, and the evolving treatment regimens for HCC. Further studies utilizing expanded, multi-institutional databases are needed to compare the outcomes of current first-line regimens, such as atezo-bev, across diverse racial and ethnic groups.