Extent and Mitigation of Financial Toxicity of Immune Checkpoint Inhibitors for the Treatment of Advanced Hepatocellular Carcinoma.

Advanced hepatocellular carcinoma (HCC) is a serious condition associated with significant morbidity and mortality. Over the past few decades, however, this has drastically changed, primarily attributed to the development of new treatments, including tyrosine-kinase inhibitors (TKIs), vascular endothelial growth factor (VEGF) inhibitors, and immune checkpoint inhibitors (ICIs). This study aims to highlight the financial toxicity (FT) of advanced HCC treatments, across diverse healthcare systems and particularly in low- and middle-income countries (LMICs). We also aim to explore potential solutions to improve access to life-saving therapies such as ICIs. We conducted an exploratory targeted review of the current literature focusing on therapeutic advancements, their accessibility, and innovative strategies to overcome FT. The review particularly addresses barriers faced in LMICs and examines initiatives that could optimize ICI availability. Findings suggest that FT significantly limits access to ICIs globally, with heightened impact in resource-limited settings and increasingly recognized in high-income countries as well. This challenge is particularly severe in LMICs, where the high incidence of HCC is compounded by the unaffordability of effective treatments, creating a significant barrier to care. Key strategies to mitigate this include cost-saving measures such as dose rounding, vial sharing, lower dosage regimens, extended dosing intervals, and shorter treatment durations. Evidence from emerging studies, predominantly in non-HCC malignancies, suggests these measures may be tolerated without unexpected safety signals. However, HCC-specific prospective data remain limited, and these approaches are entirely off-label requiring further research. Addressing financial barriers to ICI access is essential for improving outcomes in advanced HCC, globally and particularly in LMICs. Global adoption of cost-saving strategies could enhance equitable access to innovative treatments, warranting further research and collaboration among stakeholders from both high- and low-income nations.