Black, Hispanic patients with hepatocellular carcinoma less likely to receive immunotherapy
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Key takeaways:
- Immunotherapy-treated patients survived longer than those who received chemotherapy.
- Researchers observed significant disparities in early access to immunotherapy by race or ethnicity.
- Results showed greater disparities at nonacademic centers.
Black and Hispanic patients with advanced hepatocellular carcinoma had a lower likelihood than their white counterparts of receiving immunotherapy, which appeared more effective than chemotherapy for the disease, according to study results.
The findings, published in Hepatology, suggest a comprehensive approach is needed to monitor and eliminate racial and ethnic disparities in the management of advanced HCC, researchers noted.
Rationale and methods
“Historically, racial and ethnic minorities have been underrepresented in clinical trials and experimental treatments for cancer. As with other therapies, there is also a concern for potential racial and ethnic disparities in early access to immunotherapy among patients with HCC in the United States,” Ju Dong Yang, MD, gastroenterologist in the division of gastroenterology and hepatology in the department of medicine and medical director of the liver cancer program at Cedars-Sinai Medical Center, told Healio. “With the emergence of immunotherapy as a highly promising new treatment in patients with advanced HCC, it is important to investigate potential disparities and ensure that patients have equitable access to these highly effective but expensive new drugs.”
The trial included 3,990 patients (median age, 65 years) from the U.S. National Cancer Database diagnosed with tumor-node-metastasis stage III or stage IV HCC between 2017 and 2018.
Researchers performed multivariable Cox regression analysis to identify factors associated with OS, and used logistic regression analysis to identify factors associated with immunotherapy use.
Key findings
Overall, 3,248 patients received chemotherapy and 742 patients received immunotherapy as first-line treatment.
Results showed improved OS with immunotherapy compared with chemotherapy (adjusted HR = 0.76; 95% CI, 0.65-0.88) after adjusting for covariates.
Researchers found that compared with white patients, Black (adjusted OR = 0.71; 95% CI, 0.54-0.89) and Hispanic (adjusted OR = 0.63; 95% CI, 0.46-0.83) patients had a lower likelihood of receiving immunotherapy. The immunotherapy group consisted of 66.6% white, 14% Black, 10.3% Asian and 9.1% Hispanic patients, whereas the chemotherapy group included 61.9% white, 17.8% Black, 12.4% Hispanic and 7.9% Asian patients.
In addition, researchers observed a significant interaction between race and ethnicity and facility type, with a higher disparity observed in nonacademic centers (interaction P = .004).
Implications
“This is the largest study that demonstrated immunotherapy is superior to traditional systemic treatment for advanced-stage HCC in a wider patient population,” Yang told Healio. “Furthermore, our study highlighted significant racial and ethnic, socioeconomic and regional disparities in access to immunotherapy, which could be a surrogate for clinical trial participation and early access to novel experimental therapy. As the use of immunotherapy for treatment of advanced HCC will likely increase, significant disparities in access to immunotherapy need to be further investigated in future studies.”
References:
- Ahn JC, et al. Hepatology. 2022;doi:10.1002/hep.32527.
- Black, Hispanic patients less likely to get lifesaving liver cancer treatment (press release). Available at: www.cedars-sinai.org/newsroom/black-hispanic-patients-less-likely-to-get-lifesaving-liver-cancer-treatment/. Published June 7, 2022. Accessed July 26, 2022.
For more information:
Ju Dong Yang, MD, can be reached at judong.yang@cshs.org.
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