Clinical Characteristics of Patients With Advanced Hepatocellular Carcinoma Who Transitioned to Subsequent Therapies Following Systemic Therapy

AIM: This study aimed to clarify the clinical characteristics of patients with advanced hepatocellular carcinoma (HCC) who transitioned to subsequent therapies following systemic therapy (ST). METHODS: In total, 136 patients with unresectable HCC (26 hepatitis B, 47 hepatitis C and 63 others) receiving first-line ST, including 31 patients treated with immune checkpoint inhibitors (ICIs), were enrolled. Clinical characteristics and adverse events observed during treatment, as well as overall survival (OS), progression-free survival and post progression survival (PPS), were compared between patients who transitioned to subsequent therapies (2nd therapy group, n = 66) and those who did not (non-2nd therapy group, n = 70). RESULTS: Significant differences between the two groups were observed in OS (29.3 vs. 10.7 months, p < 0.001), PPS (11.3 vs. 2.9 months, p < 0.001), ALBI score (-2.48 vs. -2.34, p = 0.018), treatment with/without ICIs (24/42 vs. 7/63, p < 0.001), TNM stage (II/III/IVA/IVB; 15/26/7/18 vs. 3/27/10/30, p = 0.008) and the adverse events of appetite loss (p = 0.009) and proteinuria (p = 0.006). A favourable ALBI score (p = 0.005), treatment with ICIs (p = 0.002) and earlier TNM stage (p = 0.027) identified by logistic regression analysis and TNM stage II in men and prothrombin time ≥ 105% in women by classification tree analysis were found to be associated with a higher likelihood of transitioning to subsequent therapies. CONCLUSIONS: Initiating systemic therapy, including ICIs, before clinical stage progression and preserving the hepatic reserve is crucial for ensuring a smooth transition to subsequent therapies. REGISTRY AND THE REGISTRATION NO. OF THE STUDY/TRIAL: N/A.