Pramod Gaudel and Ghulam Rehman Mohyuddin are Hematology-Oncology Fellow Physicians, both in the Department of Internal Medicine at The University of Kansas Medical Center in Westwood. January Fields-Meehan is an Attending Physician in the Department of Hematology and Medical Oncology at the Kansas City Veterans Affairs Medical Center in Missouri. Correspondence: Pramod Gaudel (pgaudel@kumc.edu)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
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We acknowledge several limitations to our study, such as the small number of patients and the retrospective single center nature of this study. Patients were older men with multiple psychosocial comorbitities like mental illness, substance abuse, and homelessness. This cohort may not represent the non-VA population, but is an excellent representation of a frail, real-world veteran population.
Conclusions
Despite clinical trials showing the promise of immunotherapy as an attractive front-line systemic treatment option for HCC, our results show poor outcomes in a frail real-world population. In a cohort of patients who received immunotherapy as a front-line systemic treatment for HCC, results were poor with a response rate of 14.3%, a median PFS of 4 months, and a median OS of 8 months. We noted a significantly higher number of adverse effects, including 21% incidence of grade 5 hepatotoxicity. There remains an urgent need to develop more effective and safer therapies for this patient population as well as validation from larger real-world studies.
