OBJECTIVES : HCC patients with increased alpha-fetoprotein (AFP) levels have poor prognosis. This study examined real-world characteristics and treatment patterns of patients previously treated with sorafenib with AFP levels ≥400 vs. <400 ng/mL at 2L initiation across EU3 (Germany/Italy/Spain).

METHODS : Real-world data were drawn from the HCC Disease-specific Programme^TM; a point in time study administered to oncologists, hepatologists and gastroenterologists who completed patient record forms for up to the next 8 consulting HCC patients between Q4 2018/Q1 2019. Study variables included patient demographics, background clinical information and treatment patterns.

RESULTS : Physicians (n=132) provided data on 1044 patients: of which 641 are currently in 2L, of these 520 received a previous 1L sorafenib including 323 with a known AFP at 2L initiation (AFP-H [≥400ng/mL]: 52% (n=167)); (AFP-L [<400ng/mL]: 48% (n=156).

Characteristics of AFP-H/AFP-L patients were: median age 67 vs. 67 years; males 72% vs. 74%; current BCLC stage B/C 71% vs. 77%; current Child-Pugh A 23% vs. 46%, ECOG performance status 0-1 37% vs. 63% and had hepatitis B/C prior to diagnosis 46% vs. 49% respectively.

Most 2L AFP-H/AFP-L patients receive systemic treatment (70% vs. 74%), made up of TKI monotherapy (50% vs. 60%); IO only (3% vs. 11%), Chemotherapy only (16% vs. 1%) and best supportive care (30% vs. 26%). AFP-H have slightly shorter median time to 2L treatment (8.1 vs. 9.0 months), were more likely to currently have progressive disease (49% vs. 31%) and receive a supportive therapy (75% vs. 53%). Higher anti-viral use was observed for AFP-H BSC only than AFP-L BSC only patients (19% vs. 3%).

CONCLUSIONS : AFP-H HCC patients had shorter time from 1L sorafenib initiation to current 2L treatment, higher occurrence of progressive disease in 2L and reliance on supportive care, suggesting these patients are more difficult to treat.