Evolving Treatment Patterns in HCC Reflect Expanding Role of Immunotherapy
Key Takeaways:
- Sorafenib used to be the most common first-line treatment for hepatocellular carcinoma (HCC) until it was replaced by atezolizumab-bevacizumab in 2020. In 2023, durvalumab-tremelimumab emerged as a new first-line therapy and became more commonly used.
- Second-line therapies have decreased in the last decade, despite multiple options being available. Only 1 out of 5 patients with HCC received second-line therapy.
- First-line treatment type appeared to have no effect on overall survival (OS), but patients treated with atezolizumab-bevacizumab had better progression-free survival (PFS) than those treated with sorafenib.
Treatments for HCC have rapidly evolved in the past decade, but clinical trials have yet to determine optimal first-line treatment or sequencing after first-line therapy. This study examined treatment patterns and survival outcomes among patients with HCC who received treatment from 2011 to 2023.
The study used retrospective data from the Flatiron Health Research Database, which encompasses over 280 oncology practices at more than 800 US cancer clinics. The sample size included 4198 patients with HCC who were treated between 2011 and 2023.
Evolutions in HCC Treatment Patterns
From 2011 to 2020, sorafenib was the standard first-line therapy used to treat HCC until it was replaced by atezolizumab-bevacizumab. Atezolizumab-bevacizumab has remained the most common first-line treatment. In 2023, durvalumab-tremelimumab began to be used as a first-line therapy. Of the first-line treatment administrations in 2023, 60% involved atezolizumab-bevacizumab and 30.8% involved durvalumab-tremelimumab.
Of the 4198 patients assessed, 871 (20.7%) received second-line therapy for HCC. From 2016 to 2020, the most common second-line therapy was nivolumab. It was replaced by lenvatinib, which became the most frequently administered second-line therapy following first-line atezolizumab-bevacizumab.
HCC Therapies and Survival Outcomes
The median OS for the study was 8.1 months. There was no significant association between first-line treatment type and OS.
The study’s median PFS was 3.9 months. First-line atezolizumab-bevacizumab had better PFS than sorafenib.
Optimizing Treatment Sequencing to Improve Patient Outcomes
Although new therapies have emerged within the last decade, the study found that only 1 in 5 patients with HCC received second-line therapy. This decrease may be due to the improved efficacy of first-line treatments or a limited follow-up time.
According to the study’s authors, “Further research, including the use of innovative approaches to combining clinically derived datasets and randomized clinical trials, is needed to determine optimal treatment sequencing as well as strategies to increase the likelihood that patients may benefit from second-line systemic therapy options.”
Reference
Lau-Min KS, Tramontano AC, Iheanacho F, Abrams TA, Manz CR. Treatment patterns and survival outcomes among patients with hepatocellular carcinoma. JAMA Netw Open. 2025;8(12):e2551665. doi:10.1001/jamanetworkopen.2025.51665
