Purpose To compare the clinical outcomes of sorafenib plus either erlotinib or placebo in patients with advanced hepatocellular carcinoma (HCC) in a multicenter, multinational, randomized, phase III trial. Patients and Methods Patients with advanced HCC and underlying Child-Pugh class A cirrhosis, who were naive to systemic treatment (N = 720), were randomly assigned to sorafenib plus either erlotinib (n = 362) or placebo (n = 358). The primary end point was overall survival (OS). Results Median OS was similar in the sorafenib plus erlotinib and sorafenib plus placebo groups (9.5 v 8.5 months, respectively; hazard ratio [HR], 0.929; P = .408), as was median time to progression (3.2 v 4.0 months, respectively; HR, 1.135; P = .18). In the sorafenib/erlotinib arm versus the sorafenib/placebo arm, the overall response rate trended higher (6.6% v 3.9%, respectively; P = .102), whereas the disease control rate was significantly lower (43.9% v 52.5%, respectively; P = .021). The median durations of treatment with sorafenib were 86 days in the sorafenib/erlotinib arm and 123 days in the sorafenib/placebo arm. In the sorafenib/erlotinib and sorafenib/placebo arms, the rates of treatment-emergent serious AEs (58.0% v 54.6%, respectively) and drug-related serious AEs (21.0% v 22.8%, respectively) were similar. AEs matched the known safety profiles of both agents, but rates of rash/desquamation, anorexia, and diarrhea were higher in the sorafenib/erlotinib arm, whereas rates of alopecia and hand-foot skin reaction were higher in the sorafenib/placebo arm. Withdrawal rates for AEs during cycles 1 to 3 were higher in the sorafenib/erlotinib arm. Conclusion Adding erlotinib to sorafenib did not improve survival in patients with advanced HCC.

Globally suppressed T-cell function has been described in many patients with cancer to be a major hurdle for the development of clinically efficient cancer immunotherapy. Inhibition of antitumor immune responses has been mainly linked to inhibitory factors present in cancer patients. More recently, increased frequencies of CD4 ؉ CD25 hi regulatory T cells (T reg cells) have been described as an additional mechanism reducing immunity. We assessed 73 patients with B-cell chronic lymphocytic leukemia ( IntroductionHuman and murine CD4 ϩ CD25 ϩ T cells contain cells that suppress antigen-specific T-cell immune responses. [1][2][3][4][5] These naturally occurring regulatory CD4 ϩ CD25 ϩ T cells originate from the thymus and play a central role in the maintenance of peripheral tolerance by suppression of autoreactive T-cell populations. In murine models, regulatory T cells (T reg cells) prevent autoimmune and inflammatory diseases 1,6,7 and inhibit antitumor immune responses. [8][9][10][11][12] Although a truly unique marker for T reg cells is still not available, several molecules have been associated with these cells including cytotoxic T lymphocyte-associated protein 4 (CTLA4), [13][14][15][16] glucocorticoid-induced tumor necrosis factor receptor-related protein (GITR, TNFRSF18), 17,18 Forkhead box P3 (FOXP3), [19][20][21] Lselectin (CD62L, SELL), 22,23 and OX40 antigen (CD134, TNFRSF4). 23,24 In humans, T reg cells are enriched within the CD4 ϩ CD25 hi population, whereas CD4 ϩ CD25 lo T cells represent mainly previously activated T helper cells. 25 These CD4 ϩ CD25 hi T reg cells inhibit proliferation and cytokine release by conventional CD4 ϩ CD25 Ϫ T cells. 26 Decrease of these cells was found in patients with autoimmune diseases, 27-31 whereas an increase of T reg cells in patients after allogeneic bone marrow transplantation was associated with a reduced graft-versus-host disease. [32][33][34][35] In patients with malignant melanoma, 36 Hodgkin lymphoma, 37 or ovarian, 38,39 gastric, 40,41 lung, 39,42 breast, 43,44 and pancreatic cancer 43 inhibitory CD4 ϩ CD25 ϩ T cells are also increased. In an elegant study, Curiel et al 38 demonstrated that functional T reg cells were enriched in ascites from women with ovarian cancer, migrated toward CCL22 expressed by tumor cells and tumor-associated macrophages, and specifically inhibited antitumor immunity. Moreover, within this setting, the increase of T reg cells predicted poor survival. 38 Only recently, studies assessing a potential influence of chemotherapy on T reg cells have been initiated. In mice, low-dose cyclophosphamide decreased the number of T reg cells. 45 Based on these observations we were interested in understanding whether CD4 ϩ CD25 hi T cells are also increased and possess inhibitory capacities in B-cell chronic lymphocytic leukemia (CLL) and, if so, to assess the frequency and function in the context of stage of disease and prior therapy. CLL, the most common type of leukemia in the Western hemisphere, 46 is characterized by clonal proliferat...