Hepatocellular carcinoma of non-viral etiology: From theory to real practice

Introduction. Non-viral etiology of hepatocellular carcinoma (HCC) accounts for one third to one half of cases in European and American countries. In the 21st century, the role of non-alcoholic fatty liver disease is growing annually. Etiology affects the molecular genetic type of HCC, which is realized in the different effectiveness of targeted therapy and immunotherapy. Subgroup analysis of randomized trials confirms this fact. Studies of real clinical practice demonstrate similar or better treatment results with tyrosine kinase inhibitors in patients with non-viral etiology. Data on the effectiveness of HCC therapy of various etiologies in the Russian population are extremely limited and are of legitimate interest. Aim. To study the long-term results of treatment of patients with non-viral HCC in routine practice. Materials and methods. The retrospective study included patients over 18 years of age with a morphologically confirmed diagnosis of HCC established in 2021–2022, not subject to surgical or locoregional treatment due to its prevalence, without viral hepatitis, who received treatment with multikinase inhibitors at the Sverdlovsk Regional Oncology Dispensary. A total of 62 patients met the criteria: 32 received lenvatinib, 30 – sorafenib. HCC stage BCLC C was in 44 patients (71.0%), liver function according to Child–Pugh class B – in 10 (15.8%), AFP more than 400 ng/ml – in 17 (27.4 Results. First-line treatment was completed by 52 patients (83.9%), death was recorded in 40 patients (64.5%). The objective response rate was 25.8%, however, there were no complete responses, and all cases of response to treatment were partial – 16 out of 62 (25.8%). Stabilization was achieved in 39 patients (62.9%), and disease control was achieved in 55 patients (88.7%). Long-term disease control (more than 23 weeks) was 69.4% (in 43 patients). Disease progression at the first control (2–3 months after the start of treatment) was noted in 7 patients (11.3%). Second-line treatment was received by 18 out of 52 patients (34.6%). The median PFS was 10.5 months (95% CI 6.4–14.6), and the median OS was 20.5 months (95% CI 14.6 – n/a). Conclusion. The obtained remote results of treatment of patients with non-viral HCC with tyrosine kinase inhibitors demonstrate the effectiveness and safety of the chosen approach. Further study of this group of patients is required not only in clinical practice, but also in prospective randomized trials.