Annals of Hepatology (Mar 2023)

P-10 PATTERNS OF PROGRESSION AND TREATMENT DISCONTINUATION IN A REAL LIFE LATIN AMERICAN PROSPECTIVE COHORT STUDY OF INTERMEDIATE-ADVANCED HEPATOCELLULAR CARCINOMA: SECOND INTERIM ANALYSIS

  • Federico Piñero,
  • Margarita Anders,
  • Carla Bermudez,
  • Ezequiel Demirdjian,
  • Adriana Varón,
  • Ana Palazzo,
  • Jorge Rodriguez,
  • Oscar Beltrán,
  • Leonardo Gomes da Fonseca,
  • Ezequiel Ridruejo,
  • Pablo Caballini,
  • Norberto Tamagnone,
  • Virginia Reggiardo,
  • Hugo Cheinquer,
  • Diego Arufe,
  • Juan Ignacio Marín,
  • Natalia Ratusnu,
  • Estela Manero,
  • Daniela Perez,
  • Marina Villa,
  • Federico Orozco,
  • Dolores Murga,
  • Sebastián Marciano,
  • Fernando Bessone,
  • Marcelo Silva,
  • Manuel Mendizabal

Journal volume & issue
Vol. 28
p. 100914

Abstract

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Introduction and Objectives: Previously published regional real-world results of overall survival (OS) in Barcelona Clinic Liver Cancer (BCLC) B and C patients demanded a prospective cohort study nested in a systematic and continuous medical educational networking group. This study aimed to describe and evaluate the treatment decisions in patients with hepatocellular carcinoma (HCC) within BCLC B and C stages. Materials and Methods: A multicenter prospective cohort study, conducted in different Latin American centers from Argentina, Brazil and Colombia, started on 15th May 2018 (delayed recruitment during COVID locked-down period). Patients within BCLC B or C stages were included. Survival, tumor progression and patterns of treatment suspension were evaluated. Results: At this second interim analysis (projected final analysis March 2023), 390 HCC BCLC-B or C patients were included (n=15 excluded); mean age 65 years, 75.6% males and 89.5% cirrhotic. Median OS since HCC diagnosis was 27.2 months. Among BCLC-B patients, the most frequent therapy was transarterial chemoembolization (TACE, 42.3%); 51.8% using drug-eluting beads and 47.4% conventional TACE; with a median OS since 1st TACE of 41.9 months. Similar radiological responses after 1st TACE were observed between both modalities. Overall, 48.2% of the cohort received systemic therapy for HCC (n=188), 23.7% still on BCLC-B stage. The most frequent systemic treatments were Sorafenib (74.5%), atezolizumab bevacizumab (17.5%), and lenvatinib (12.2%), with a median OS since systemic therapy of 15.7 months. Lenvatinib or atezolizumab bevacizumab was used as the second line following sorafenib in 5 and 3 patients, respectively. The most common causes of systemic treatment discontinuation were tumor progression and liver function deterioration (15% to 36.4%). Patterns of tumor progression were not specifically associated with prognosis or treatment discontinuation. Conclusions: Liver function deterioration occurs in a third of patients following systemic therapies. The complexity of treatment decisions underly the need for a multidisciplinary team and the role of hepatologists.