Evolving practices, treatment decisions, and unmet needs in intermediate-stage hepatocellular carcinoma: An Asia Pacific perspective

Abstract

BACKGROUND

Until recently, the use of systemic therapies among patients with intermediate-stage hepatocellular carcinoma (iHCC) was limited. However, this has recently become a topic of interest in the treatment of patients who are also eligible for locoregional therapy (LRT). The combination of LRT with systemic therapy in patients with iHCC has been investigated in multiple clinical trials, with guidelines recently updated to reflect this.

AIM

To investigate current iHCC management and address readiness to adopt systemic therapy and LRT combinations among physicians in Asia.

METHODS

An online survey addressing the surveillance and diagnosis of hepatocellular carcinoma (HCC), the role of treatment decision makers and the multidisciplinary team in iHCC, current treatment approaches and decision-making practices in iHCC, and options for improving outcomes for patients with iHCC was developed and administered to physicians from seven Asian countries (Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam). One-to-one follow-up interviews were conducted with three physicians from each country to verify the survey results and further understand country-wide practices.

RESULTS

Seventy of 135 invited physicians completed the survey (response rate 51.9%). Conventional transarterial chemoembolization (C-TACE) was the preferred first-line treatment for Barcelona Clinic Liver Cancer (BCLC) stage B1-2 iHCC, while systemic therapy alone or in combination with LRT was the preferred first-line treatment for BCLC-B3 or BCLC-C HCC. Among 54 self-identified prescribers, 98.1% had experience of using a systemic therapy in combination or sequence with LRT, and systemic therapies were most commonly combined or sequenced with C-TACE. While 94.3% of respondents had access to a multidisciplinary team for the management of iHCC, gastroenterologists/hepatologists were seen as the primary treatment decision maker by 44.3% of respondents. Barriers to the adoption of systemic therapy and LRT combinations included evidence gaps and cost/reimbursement status.

CONCLUSION

This survey gives a snapshot of real-world iHCC management across Asia and provides evidence of a growing role for locoregional and systemic therapy combinations in the management of iHCC.

Keywords: Intermediate hepatocellular carcinoma; Hepatocellular carcinoma; Systemic therapy; Locoregional therapy; Survey; Physician survey

Core Tip: The integration of systemic therapy with locoregional therapy (LRT) for the treatment of intermediate-stage hepatocellular carcinoma (iHCC) is rapidly becoming an area of interest. In this physician-targeted survey, 98.1% of prescribers had experience using a systemic therapy in combination or sequence with LRT for the treatment of iHCC. Patients with Barcelona Clinic Liver Cancer stage B2 and B3 iHCC were seen as ideal candidates for such combinations; however, barriers to access included lack of evidence for combination-therapy use and cost/reimbursement status of approved treatments.