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

backgroundThere are substantial historical racial and ethnic differences in treatment survival for patients with hepatocellular carcinoma (HCC) that may have changed with approval of 9 novel systemic HCC therapies between 2017 and 2022.

methodsThis retrospective cohort study included patients from the Flatiron Health Research Database who received systemic therapy between 2011 and 2023. We identified receipt of systemic therapy, including novel systemic therapies receiving US Food and Drug Adminstration approval ≥2017, and determined overall survival (OS) from start of first-line systemic therapy until death. Multivariable models adjusted for sociodemographic and clinical factors.

resultsThe study included 4198 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 to 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 with 8.0 and 8.3 months for White and non-Hispanic patients. Asian (HR = 0.79, 95% CI = 0.65 to 0.96) and Hispanic patients (HR = 0.72, 95% CI = 0.62 to 0.83) had better OS than White and non-Hispanic patients, respectively, which did not substantially change with stepwise adjustment. Racial differences in survival worsened over time. Receipt of novel therapy was associated with improved survival.

conclusionsAsian 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.