Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 9;13(3):298-313.
doi: 10.1159/000534513. eCollection 2024 Jun.

Real-World Data on the Diagnosis, Treatment, and Management of Hepatocellular Carcinoma in the Asia-Pacific: The INSIGHT Study

Yu Ki Sim  1 , Ming Chuen Chong  2 , Mihir Gandhi  3   4   5 , Yogesh Mahadev Pokharkar  3 , Yanan Zhu  6 , Luming Shi  6 , Li Lequn  7 , Chien-Hung Chen  8 , Masatoshi Kudo  9 , Joon Hyeok Lee  10 , Simone I Strasser  11 , Rawisak Chanwat  12 , Pierce K H Chow  1   13   14 ; Asia-Pacific Hepatocellular Carcinoma Trials Group
Affiliations

Real-World Data on the Diagnosis, Treatment, and Management of Hepatocellular Carcinoma in the Asia-Pacific: The INSIGHT Study

Yu Ki Sim et al. Liver Cancer. .

Abstract

Introduction: Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the third leading cause of cancer death worldwide. While there has been rapid evolution in the treatment paradigm of HCC across the past decade, the extent to which these newly approved therapies are utilized in clinical practice in the real world is, however, unknown. The INSIGHT study was an investigator-initiated, multi-site longitudinal cohort study conducted to reflect real-world epidemiology and clinical practice in Asia-Pacific in the immediate 7-year period after the conclusion of the BRIDGE study.

Methods: Data were collected both retrospectively (planned 30% of the total cohort size) and prospectively (planned 70%) from January 2013 to December 2019 from eligible patients newly diagnosed with HCC from 33 participating sites across 9 Asia-Pacific countries.

Results: A total of 2,533 newly diagnosed HCC patients (1,052 in retrospective cohort and 1,481 in prospective cohort) were enrolled. The most common risk factor was hepatitis B in all countries except Japan, Australia, and New Zealand, where the prevalence of hepatitis C and diabetes were more common. The top three comorbidities reported in the INSIGHT study include cirrhosis, hypertension, and diabetes. We observe high heterogeneity in the first-line treatment recorded across countries and across disease stages, which significantly affects survival outcomes. Stratification by factors such as etiologies, tumor characteristics, the presence of extrahepatic metastases or macrovascular invasion, and the use of subsequent lines of treatment were performed.

Conclusion: The INSIGHT study describes a wide spectrum of clinical management practices in HCC, where patient demographics, differential costs, and patient access to therapies may lead to wide geographical variations through the patient's treatment cycle, from diagnosis to clinical outcome. The high heterogeneity in patient outcomes demonstrates the need for more robust and clinical management strategies to be designed and adopted to bring about better patient outcomes.

Keywords: Asia-Pacific; Epidemiology; Hepatocellular carcinoma; Liver cancer.

PubMed Disclaimer

Conflict of interest statement

P.K.H.C. received honoraria from La Hoffman-Roche and Sirtex Medical; received research funding from Sirtex Medical, Ipsen, IQVIA, New B Innovation, AMiLi, Perspectum, MiRXES, and La Hoffman-Roche; and holds a consultancy or advisory role in Sirtex Medical, Ipsen, BMS, Oncosil, Bayer, New B Innovation, MSD, Guerbet, Roche, AUM Bioscience, L.E.K. Consulting, AstraZeneca, Eisai, Genentech, IQVIA, and Abbott. S.I.S. received honoraria from Eisai, Roche Products, AstraZeneca, Gilead Sciences, Pfizer, Chiesi, Bayer, Sirtex Medical, AbbVie, Norgine, and MSD. M.K. received honoraria from Chugai, Eisai, Eli Lilly, and Takeda; received research funding from Otsuka, Taiho, Chugai, GE Healthcare, Eisai, AbbVie, and EA Pharma; and holds a consultancy role in Chugai, Roche, Eisai, and AstraZeneca. All other authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Study design of the INSIGHT study.
Fig. 2.
Fig. 2.
Distribution of recruited patients by country.
Fig. 3.
Fig. 3.
Kaplan-Meier analysis of median overall survival across BCLC stage (a), for BCLC 0-A across countries (b), for BCLC B across countries (c), for BCLC C across countries (d).
Fig. 4.
Fig. 4.
Bubble plot of mOS at the country level stratified by BCLC staging. Bubble size indicates relative cohort size.
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209–49. - PubMed
    1. Zhang CH, Cheng Y, Zhang S, Fan J, Gao Q. Changing epidemiology of hepatocellular carcinoma in Asia. Liver Int. 2022 Aug;42(9):2029–41. - PubMed
    1. Jafri W, Kamran M. Hepatocellular carcinoma in Asia: a challenging situation. Euroasian J Hepatogastroenterol. 2019;9(1):27–33. - PMC - PubMed
    1. Rumgay H, Arnold M, Ferlay J, Lesi O, Cabasag CJ, Vignat J, et al. . Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022 Dec;77(6):1598–606. - PMC - PubMed
    1. Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, et al. . Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017 Jan 7;389:56–66. - PubMed