Investigating disparities in hepatocellular carcinoma and their effect on patterns of systemic care: An updated analysis.

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489 Background: Hepatocellular carcinoma (HCC) disproportionately affects minorities, particularly Black and Hispanic patients, and those of lower socioeconomic status (SES). Data on the impact of disparities on patterns of systemic treatment (STx) for metastatic HCC (mHCC) in these disadvantaged groups remain limited. Initial retrospective analysis of this large real-world database (2011-2021) did not reveal significant STx disparities based on race/ethnicity (R/E) or insurance but suggested that many patients with mHCC may be undertreated. This updated analysis included SES index data and aimed to further characterize STx patterns through 2024. Methods: 1754 patients diagnosed with HCC from 2011 to 2024 with known R/E, insurance, SES index, documented metastatic disease, and without prior transplant from the US-based, deidentified, electronic health record-derived Flatiron Health Research Database were selected and analyzed. Chi-squared tests, T-tests, and Gray’s test were used to assess how R/E, insurance (Medicaid vs non-Medicaid), and SES index were related to HCC risk factors, number of lines of STx (LOT), and time from metastatic diagnosis to start of STx. Results: There were 1066 white (W), 253 Black (B), 134 Hispanic (H), 98 Asian (A), and 203 patients with other race. Most patients were in the 2 lowest SES indices (46.2%, n=810) and the smallest proportion were in the highest SES index (14.1%, n=247). There were more B and H patients in the lowest SES and more A and W patients in the highest SES index (p<0.001). There was no difference in median time to STx (1.02 months) or total approved LOT based on R/E, insurance, or SES. 40% did not receive any STx, 44% received 1 LOT, and 16% received > 2 LOT. These rates of treatment were similar compared to prior analysis. Asian patients continued to have a numerically higher rate of >2 LOT (A: 23.5%, B 19.4%, H 17.9%, W 15.3%; p=0.21) and had a higher cumulative incidence of STx followed by B, H, then W patients (p = 0.03). Uptake of novel STx between 2018-2024 was gradual without significant differences based on R/E, insurance, or SES. In 2023-24, most patients received atezolizumab + bevacizumab (50.6%, n=82) or durvalumab + tremelimumab (40.7%, n=66). Nivolumab (n=98, 27.7%) and lenvatinib (n=38, 10.7%) were the most common second-line therapies (n=354). Conclusions: This updated real-world analysis reveals, unlike patterns of curative therapies, there were no significant STx disparities based on R/E, insurance, or SES. Overall STx patterns remained stable with gradual uptake of novel therapies across groups. However, undertreatment of mHCC persists with 40% of patients not receiving any STx and only 16% receiving >2 LOT. These findings underscore a persistent gap in care delivery in the US and highlight opportunities for improving access to STx in a population projected to have the highest HCC burden over the next decade.

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