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Advances in therapy are improving outcomes for patients, but the incidence and mortality rates for hepatocellular carcinoma are increasing in the US.
Recent research in hepatocellular carcinoma (HCC) highlighted the importance of screening and touted advances in outcomes with new immunotherapy treatments. However, the data shows an increase in incidence and mortality rates for HCC in the US.
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For patients with known risk factors, screening for HCC is important as it is associated with reduced mortality, according to a study published in April in JAMA Network Open. Of the patients included, 42.3% had HCC that was detected via screening. The mortality rate for these patients was significantly lower than that for the 57.7% of patients with HCC cases that had not been detected by screening. In addition, patients with screen-detected HCC were more likely to receive curative treatment than the patients with HCC not detected through screening.
In this interview from June, Amit Singal, MD, medical director of the Liver Tumor Program and chief of hepatology at University of Texas Southwestern Medical Center, explained that the development of immunotherapies and combination regimens has advanced the treatment of HCC and extended the median survival.
“I think, in general, we've seen significant improvement in outcomes, responses, progression-free survival, and overall survival for patients across the board, given the introduction of immune checkpoint inhibitors in the therapeutic landscape,” he said.
The EMERALD-1 trial results, presented at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium in January, found adding durvalumab and bevacizumab to transcatheter arterial chemoembolization (TACE) boosted progression-free survival by almost 7 months. For 20 years, TACE has been the standard of care for patients with unresectable HCC who can receive embolization, but recurrence remains common. According to Cathy Eng, MD, FACP, FASCO, codirector of GI Oncology and coleader of the Gastrointestinal Cancer Research Program at Vanderbilt University Medical Center, the results of EMERALD-1 “have the potential to establish a new standard of care for the treatment of unresectable hepatocellular carcinoma.”
However, a small study found that adding PD-1 inhibitors to TACE plus lenvatinib for HCC had no benefit over TACE plus lenvatinib alone, although the authors noted the results needed to be validated in further research. The results from the retrospective, single-center study were published in June and only included 35 patients with unresectable HCC. The small sample size limited subgroup analysis to determine if any subpopulations could benefit from the addition of PD-1 inhibitors more than other patients.
The incidence rates of HCC are known to have increased, but this study added to the knowledge of demographic-specific incidence and mortality trends in the US. In addition to incidence rates increasing, so have mortality rates, and there are disparities between men and women in a range of racial/ethnic groups, according to this research published in January in Journal of Clinical and Translational Hepatology. Among younger adults, only men saw a decrease in incidence. There was declining mortality in younger adults across racial and ethnic groups, but especially among non-Hispanic American Indian/Alaska Native patients.