Efficacy of First-line Systemic Treatment in Unresectable or Advanced Hepatocellular Carcinoma in Thailand: A Retrospective Study
Piyakarn Watcharenwong1, Songrit Pongpan1, Aumkhae Sookprasert1, Kosin Wirasorn1, Thanachai Sanlung1, Siraphong Putraveephong1, Wattana Sukeepaisarnjaroen2, Vasin Thanasukarn3, Jarin Chindaprasirt1
Affiliation : 1 Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand 2 Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand 3 Department of Surgery, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
Background: First-line systemic treatments for unresectable or advanced hepatocellular carcinoma (HCC) are gradually increasing. In developing countries, including Thailand, there are limitations to access some effective treatments. We aim to explore the real-world efficacy of first-line systemic therapy in patients with unresectable or advanced hepatocellular carcinoma.
Objective: The primary objective was the progression-free survival (PFS) of the tyrosine-kinase inhibitors (TKIs) group compared with the FOLFOX group. Secondary objectives included PFS, overall survival (OS), response rate by treatment types, and the identification of prognostic factors associated with PFS and OS.
Materials and Methods: A single-center, retrospective study was conducted on patients diagnosed with unresectable or advanced hepatocellular carcinoma who received first-line systemic therapy between January 2017 and December 2022.
Results: In the overall population (n=215), most patients were male, had ECOG performance status 0-1, Child-Pugh score A, viral-hepatitisassociated disease, and Barcelona Center of Liver Cancer (BCLC) stage C. In the TKIs group (n=134), the median PFS was 3.4 months, compared with 2.9 months in the FOLFOX group (n=68) (HR=0.73, 95% CI 0.54 to 0.99, p=0.044). The median PFS was 3.0 months, 4.8 months, and 11.7 months in the sorafenib (n=108), lenvatinib (n=26), and atezolizumab plus bevacizumab groups (n=13), respectively. The median OS was 8.1, 9.2, 11.0, and 19.4 months in the FOLFOX, sorafenib, lenvatinib, and atezolizumab plus bevacizumab groups, respectively. The objective response rates were 5.8%, 1.9%, 15.4%, and 30.8% in the FOLFOX, sorafenib, lenvatinib, and atezolizumab plus bevacizumab groups, respectively. The actor associated with PFS was viral hepatitis-associated disease, while the factors associated with OS were Child-Pugh score, ALBI score, and macrovascular invasion status.
Conclusion: TKIs provide longer PFS. FOLFOX demonstrates similar PFS but higher response rates and disease control compared to sorafenib. The viral-related disease was associated with PFS, while child-Pugh score, ALBI score, and vascular invasion were the factors associated with OS.
Received 11 March 2024 | Revised 19 June 2024 | Accepted 26 June 2024
DOI: 10.35755/jmedassocthai.2024.S01.S71-S78
Keywords : Hepatocellular carcinoma; HCC; FOLFOX; Sorafenib; Lenvatinib; First-line
