3019 - The Role of Oligoprogression Radiotherapy in Delaying Second-Line Therapy in Patients with Hepatocellular Carcinoma

B. Leng¹, Y. Ge¹, H. Wang², R. Feng¹, K. Zhu¹, F. Shi¹, S. Jiang¹, X. Zhang¹, and J. Yue¹; ¹Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, ²Shandong University Cancer Center, Cheeloo College of Medicine, ShanDong University, Jinan, China

Purpose/Objective(s): The effectiveness of second-line therapy following initial first-line treatment for oligoprogression hepatocellular carcinoma (HCC) remain dismal. This study aims to evaluate whether the addition of radiotherapy to oligoprogressive lesions in combination with continuous first-line therapy can improve clinical outcomes in patients with oligoprogressive HCC compared with second-line therapy combined with radiotherapy or alone. Materials/

Methods: A retrospective cohort of 84 patients exhibiting oligoprogression subsequent to initial HCC treatment were enrolled between October 2018 and April 2023. After propensity match based on age, sex, BCLC stage, Child-pugh grade and ECOG grade, these patients underwent either radiotherapy for oligoprogression lesions combined with continuous first-line therapy (n=31, 37%), radiotherapy for oligoprogression lesions along with second-line therapy (n=27, 32%), or second-line therapy alone (n=26, 31%). Our primary endpoint was progression-free survival (PFS) and second endpoint was overall survival (OS).
Results: When comparing oligoprogression lesion radiotherapy plus continuous first-line therapy to second-line therapy alone, the PFS was 7.45 months versus 3.2 months (95% CI 0.11-0.42, HR 0.22, p<0.0001). Similarly, when comparing oligoprogression lesion radiotherapy plus second-line therapy to second-line therapy alone, the PFS was 5 months versus 3.2 months (95% CI 0.24-0.76, HR 0.43, p=0.0028). When comparing oligoprogression lesion radiotherapy plus first-line therapy to oligoprogression lesion radiotherapy plus second-line therapy, PFS was 7.45 months compared to 5 months (95% CI 0.89-2.58, HR 1.51, p=0.13). The OS has not been reached.
Conclusion: In comparison, the combination of radiotherapy with continuous first-line therapy has greater potential to benefit HCC patients than the combination of radiotherapy with switched second-line therapy or second-line therapy alone. The study suggests that incorporating radiotherapy into the management of oligoprogression in HCC without switching to second-line treatment and optimizing the role of first-line treatment may have potential clinical utility, providing insights for optimizing treatment strategies in this patient population.