National Survey of Real-World Australian Treatment Patterns for Patients With Very-Early-To Intermediate-Stage Hepatocellular Carcinoma

Background/Purpose of the Study: The treatment landscape for very early to intermediate stage hepatocellular carcinoma (HCC) is rapidly evolving, with new data and treatments emerging in recent years. There is a lack of data on current patterns of management for very early to intermediate stage HCC in Australian clinical practice and the role of newly emerging treatment options. 

Methods: Multidisciplinary specialists involved in HCC management (N = 86) participated in one of six state-based meetings across Australia. Specialists were surveyed on their preferred management approaches at key clinical decision points for four patient case studies ranging from very early to intermediate stage HCC. 

Results: Preferred management strategies for each of the patient case studies were largely consistent with current Australian HCC recommendations in relation to surveillance, diagnosis, and treatment of HCC although the preferred initial treatment selection varied considerably within and between hepatologists and other craft groups. There was, however, growing interest in emerging treatments, including stereotactic ablative body radiotherapy (SABR) for early stage HCC and systemic treatments used as adjuvant therapy or in combination with locoregional therapy in early and intermediate-stage HCC. However, many participants required more data on these treatment modalities before incorporating them into routine clinical practice. 

Conclusion: The heterogeneity of (very) early to intermediate-stage HCC patients and the increasing number of available treatment options means clinical decision-making, including treatment selection, is becoming more complex and diverse. More data are required to define the role of SABR and systemic therapies in very early to intermediate stage HCC before being adopted as standard of care in Australia.