Document resource
Background The treatment of Hepatocellular carcinoma (HCC) has seen significant changes in the past decade with the introduction of immunotherapy. These treatments, however, were mostly tested in patients of Asian and European ancestry in well-resourced settings. We sought to define immunotherapy outcomes in the diverse and underserved patient population in the Bronx.Methods We reviewed the medical records of patients with HCC treated with immunotherapy between January 2018 and January 2025. We collected patient demographics and established biomarkers of prognosis including Child Pugh (CP) score, Model for End Stage Liver Disease (MELD)-Na score, and Neutrophil- Lymphocyte ratio(NLR). Median overall survival(mOS) from time of initiation of Immunotherapy was calculated using Mantel- Cox test and survival was analyzed using Kaplan- Meier curves and categorical variables were compared using a Chi Square test with significance defied as two-tailed p value <0.05 (Prism Graphpad v10.)Results A total of 298 patients were included with 42.6% Hispanic and 22.1% Non-Hispanic Blacks compared to 3% and 2% respectively in the landmark IMBRAVE study. As of 1/30/25, 185 patients had died, and 85 patients were known to be alive, with 28 patients lost to follow up. 123 patients were treated with first line immunotherapy and the rest received treatment in later line setting. Amongst evaluable patients,162 patients were CPA, 90 CPB and and 26 patients were CPC with mOS 23, 8, and 3 months respectively (p<0.001). Amongst CPA disease treated in the first line setting, mOS was 25 months. Compared to non-hispanics, improved survival in Hispanic patients with CPA disease treated first line was seen (mOS 29 months vs 16 months, p=0.0514). Overall survival from diagnosis in Hispanic vs non-hispanics was significantly better (46 months vs 25 months). NLR<3.5, CLIP<3, and AFP<400 were all associated with prolonged survival (p<0.05). MELD-Na was particularly useful in discriminating patients likely to have poor outcomes, identifying a minority of 9 patients who had MELD-Na greater than 17 with mOS of only 7 months treated in the first line setting whereas 114 patients had a mOS of 29 months.Conclusions Immunotherapy is highly effective in diverse populations with HCC, comparing favorably with the published data for Imbrave150 (mOS 19 months). Hispanic patients may have better outcomes than non-hispanic patients, consistent with the previously reported ‘Hispanic paradox’ whereby Hispanics have improved outcomes in multiple malignancies. MELD-Na may be a useful way to identify patients who are likely to have meaningful survival on immunotherapy.Ethics Approval The IRB protocol was approved by Einstein IRB.