HOUSTON — For veterans with hepatocellular carcinoma (HCC), research presented today at the 2018 American Society of Clinical Oncology Annual Meeting in Chicago offers encouraging the news. The study determined that a new tyrosine kinase inhibitor (TKI) significantly improves progression free and overall survival patients with HCC in both young and older patients.1
That’s significant because most cases of HCC at the VA develop following decades of infection with hepatitis C virus, so veterans tend to be over 65 when diagnosed. Veterans also develop the disease at about five times the rate seen in the general population. The number of veterans with HCC has steadily risen from about 500 in 2002 to 4,900 in 2013 to more than 8,000 in 2017, according to the VA.
While nearly all veterans who have been diagnosed with HCV will have been offered curative treatment with direct acting antivirals, those who had cirrhosis at the time of treatment may still go on to develop HCC, according to Jennifer Kramer, PhD, MPH, an investigator with the Clinical Epidemiology & Comparative Effectiveness Program, Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center in Houston.
The phase III CELESTIAL study of 707 patients who had previously received system treatment for advanced hepatocellular carcinoma found that cabozantinib improved median overall survival by 25% and median progression free survival from 1.9 months to 5.2 months, a risk reduction of 56%. Cabozantinib is a TKI that targets VEGF, MET and TAM receptors. The median age of study participants was 64 years.
When investigators broke down the results by age, they found no significant difference in median progression free survival between patients 65 or older and those younger than 65; both groups saw about a 55% improvement with cabozantinib compared to placebo. Patients receiving placebo who were 65 or older had a median overall survival of 7.7 months, while younger patients had a median overall survival of 8.3 months for placebo. Median overall survival in the older group was 9.6 months and 11.1 months in the younger group for cabozantinib.
Older patients had twice the discontinuation on cabozantinib than younger patients, but both groups had similar rates of dose reduction and similar median average daily dose of cabozantinib.
1Rimassa L, Cicin I, Blanc JF, et al. Outcomes based on age in the phase 3 CELESTIAL trial of cabozantinib versus placebo in patients with advanced hepatocellular carcinoma. J Clin Oncol 36, 2018 (suppl; abstr 4090).