Vogel Discusses Real-World Survival Data of Immunotherapy in HCC

Arndt Vogel, MD, the managing senior consultant and professor in the department of Gastroenterology, Hepatology, and Endocrinology, at the Hannover Medical School, discusses the real-world data of immunotherapy (IO) combinations in hepatocellular carcinoma (HCC)

According to Vogel, IO combinations have an observed median overall survival of approximately 20 months. With tyrosine kinase inhibitors, the median overall survival is 12 to 13 months.

For patients with intermediate-stage disease, meaning the tumor is confined to the liver, the standard of care is trans arterial chemoembolization. This therapy has a median overall survival of anywhere between 20 to 35 months, according to numerous phase 3 studies. Vogel says that this reflects the wide range of patients included in clinical trials. Real-world data however found that this therapy has a median overall survival of less than 20 months. According to Vogel, this is due to the wide indication of trans arterial chemo embolization and that real-world patients tend to be sicker than those in the academic setting.

0:08 | For the IO combinations in advanced disease, we have observed a median overall survival of almost 20 a month. It's pretty great. TKI's, we usually observe a median overall survival of 12 to 13 months. So, there was an almost six-month improvement. For local therapies, and local therapies are the standard of care for patients in intermediate stages. So, patients with the tumor confined to the liver, no vascular infiltration, no extra hepatic metastases, these patients we usually use trans arterial chemo embolization. And when we look at the outcome in the phase 3 studies using these, they have a median overall survival of around 20 to 35 months. So, there's a wide heterogeneity, which reflects the inclusion of patients in the different trials. In the real-world cohort median overall survival is much shorter, usually below 20 months, which is most likely a reflection of a broader indication for this therapy and probably patients that we would not treat within a clinical trial, have receive these in a real-world setting. So, I think we need to really distinguish a lot of clinical trial population and to real-world population. At the moment we're in a transition period very, very restrictive, but the local therapist and may use these IO based combinations more frequently in earlier stages.