Disparities in Access to Immunotherapy for HCC

Significant disparities in early access to immunotherapy for advanced hepatocellular carcinoma (HCC) exist among racial and ethnic groups, possibly due to differences in access to clinical trials and experimental therapies, according to researchers writing in the journal Hepatology.

“Immunotherapy has emerged as an effective treatment for patients with advanced-stage HCC,” the authors stated. “We aimed to investigate the efficacy of immunotherapy for advanced HCC in a nationwide cohort and racial and ethnic disparities in access to immunotherapy.”

The investigators identified patients diagnosed with tumor-node-metastasis stage 3 or 4 HCC between 2017 and 2018 from the US National Cancer Database to identify patients. Using multivariable Cox regression, they looked for factors associated with overall survival (OS) and through logistic regression identify characteristics that were associated with whether patients had received immunotherapy.

“Out of 3,990 patients treated for advanced HCC, 3,248 (81.4%) patients received chemotherapy and 742 (18.6%) patients received immunotherapy as a first-line treatment,” they reported. “Immunotherapy was associated with improved OS compared with chemotherapy (adjusted HR: 0.76, 95% CI: 0.65–0.88) after adjusting for covariates.”

They further found that Hispanic (adjusted OR [aOR]: 0.63, 95% CI: 0.46–0.83) and Black patients (aOR: 0.71, 95% CI: 0.54–0.89) were less likely to receive immunotherapy compared with White patients, and that race-ethnicity and facility type were strongly associated, with higher disparity between racial/ethnic groups seen among nonacademic centers.

“A comprehensive approach to monitoring and eliminating racial-ethnic disparities in the management of advanced HCC is urgently needed,” they concluded.

—Rebecca Mashaw

Reference:

Ahn JC, Lauzon M, Luu M, et al. Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States. Hepatology. 2022;76(6):1649-1659.  https://doi.org/10.1002/hep.32527