Work

Disparate patterns of disease time burden in patients with HCC on immunotherapy or tyrosine kinase inhibitors

Year: 2025

Type: article

Abstract: Background & Aims While cancer survivorship for hepatocellular carcinoma (HCC) has improved, associated disease time burden in patients on systemic therapies remains poorly understood. We utilized days at home (DAH), a patient-centered metric, to compare the disease time burden between patients on immunotherapies and tyrosine kinase inhibitors (TKIs). Methods HCC patients receiving systemic therapy from 2008-2023 were identified from a population-based cohort. Patients were classified based on the use of immunotherapy (nivolumab, pembrolizumab, atezolizumab, durvalumab, tremelimumab, and ipilimumab; including monotherapies or combinations) or TKI (lenvatinib, sorafenib, cabozantinib, and regorafenib). The primary outcome was DAH, defined as days alive and not requiring healthcare utilization within the first year of systemic therapy. Results This study included 4,677 patients (immunotherapy: 578, TKI: 3,410, both immunotherapy and TKI: 689). Immunotherapy use, when compared with TKI, was associated with higher 1-year overall survival (58.1% vs 34.2% respectively, p<0.001) and higher mean DAH (223.1 vs 183.3 days respectively, p<0.001). Immunotherapy was associated with fewer days spent on inpatient stay and emergency department attendance, but more days spent on day procedures and investigations (all p<0.01). Immune-related adverse events (irAEs) occurred in 12.3% of immunotherapy patients, and independently predicted lower probability of achieving DAH ≥180 days within the first year of therapy (HR 0.523, 95%CI 0.290-0.942, p=0.031). Immunotherapy patients with irAEs had comparable DAH as TKI patients (p=0.469). Conclusions Immunotherapy was associated with reduced disease time burden in HCC when compared with TKI. However, this benefit is dampened with the occurrence of irAEs. Our data has quality-of-life implications, and may influence patients' treatment decisions. IMPACT AND IMPLICATIONS This study utilized days at home (DAH), a patient-centered metric, to assess the disease time burden in advanced hepatocellular carcinoma patients on systemic therapies. We demonstrated that immunotherapy was associated with higher DAH than in tyrosine kinase inhibitor treatment, although this benefit is dampened with the occurrence of immune-related adverse events. These findings have quality-of-life implications, and can be used for patient counselling.

Source: JHEP Reports

DOI: 10.1016/j.jhepr.2025.101578