OBJECTIVES: To describe the real-world second-line (2L) treatment patterns and disease burden of patients with unresectable or advanced hepatic carcinoma (HC) in China.

METHODS: All adult unresectable or advanced HC patients receiving 2L treatment were identified from the Tianjin Healthcare and Medical Big Data Platform, a regional electronic health record database in Tianjin, China. Patients were identified between JAN 2018 to SEP 2021, and observed until DEC 2021. Index date was the first date receiving HC 2L treatment. Descriptive analysis was conducted for study outcomes for the overall cohort and by subgroups before and after National Reimbursement Drug List (NRDL) 2020 version implementation.

RESULTS: A total of 123 patients were eligible for study inclusion. Targeted therapy (n=93, 75.6%) was the most commonly used 2L treatment category and regorafenib monotherapy (n=71, 57.7%) was the most common treatment type. Among patients receiving regorafenib as 2L treatment, sorafenib was the most used first-line treatment. The percentage of patients using 2L treatments recommended by 2020 China Society of Clinical Oncology (CSCO) guideline changed from 87.2% to 59.2% after NRDL 2020 version implementation. The mean treatment duration increased from 2.0 to 2.9 months after NRDL 2020 version implementation. The mean total cost related to 2L treatment per month reduced from 26,942 to 16,804 Chinese Yuan (CNY) after NRDL 2020 version implementation, primarily driven by reduced drug cost (18,869 vs. 10,072 CNY) and testing cost (4,051 vs. 2,547 CNY).

CONCLUSIONS: Targeted therapy, especially regorafenib, was the most common 2L treatment against unresectable or advanced HC in China. Due to increased innovative choices for HC treatment since NRDL 2020 version implementation, the percentage of patients using 2L treatment consistent with the recommendation of 2020 CSCO guidelines changed. There was a trend towards increased treatment duration and reduced total cost after NRDL 2020 version implementation.