Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma

Abstract

AIM:To compare the overall survival (OS) and progression-free survival (PFS) with associated adverse events (AE) in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) + sorafenib vs TACE alone. METHODS:In this retrospective cohort study we collected data on all consecutive patients with a diagnosis of unresectable HCC between 2007 and 2011 who had been treated with TACE + sorafenib or TACE alone. We hypothesized that the combination therapy is superior to TACE alone in improving the survival in these patients. Data extracted included patient's demographics, etiology of liver disease, histology of HCC, stage of liver disease with respect to model of end stage liver disease score and Child-Turcotte-Pugh (CTP) classification and Barcelona Clinic Liver Cancer (BCLC) staging for HCC. Computed tomography scan findings, alpha fetoprotein levels, number of treatments and related AE were also recorded and analyzed. RESULTS:Of the 43 patients who met inclusion criteria, 13 were treated with TACE + sorafenib and 30 with TACE alone. There was no significant difference in median survival: 20.6 mo (95%CI: 13.4-38.4) for the TACE + sorafenib and 18.3 mo (95%CI: 11.8-32.9) for the TACE alone (P = 0.72). There were also no statistically significant differences between groups in OS (HR = 0.82, 95%CI: 0.38-1.77; P = 0.61), PFS (HR = 0.93, 95%CI: 0.45-1.89; P = 0.83), and treatmentrelated toxicities (P = 0.554). CTP classification and BCLC staging for HCC were statistically significant (P = 0.001, P = 0.04 respectively) in predicting the survival in patients with HCC. The common AE observed were abdominal pain, nausea, vomiting and mild elevation of liver enzymes. CONCLUSION:Combination therapy with TACE + sorafenib is safe and equally effective as TACE alone in patients with unresectable HCC. CTP classification and BCLC staging were the significant predictors of survival. Future trials with large number of patients are needed to further validate this observation.

Sorafenib continuation or discontinuation in patients with unresectable hepatocellular carcinoma after a complete response

“…This contradicts studies showing the effectiveness of TACE with sorafenib for intermediate-advanced HCC [ 11 – 14 ], but might be explained by the inclusion of more advanced stage patients with fewer CRs in those studies. On the other hand, we confirm the results of another report [ 18 ] showing that TACE plus sorafenib achieved a comparable effectiveness to treatment with TACE alone for patients with HCC (most patients were BCLC stage A and B). Similarly, Cabrera et al [ 12 ] reported that the combination of TACE and sorafenib achieved a median survival time of 18.5 months for patients with BCLC stage B.…”

Managing localized unresectable hepatocellular carcinoma

“…18 TACE can cause local hypoxia, which increases levels of vascular endothelial growth factor receptor (VEGF). 18 TACE can cause local hypoxia, which increases levels of vascular endothelial growth factor receptor (VEGF).…”

“…18 Researchers suggested that the combination therapy of TACE plus sorafenib was safe and equally effective to TACE alone in patients with unresectable hepatocellular carcinoma. The most common adverse reactions reported for both treatment groups were abdominal pain, nausea, vomiting, and mild elevation of liver enzymes.…”

Transarterial Chemoembolization With Doxorubicineluting Microspheres: Single-Center Review Of Safety Profile

“…Molecular biology studies have shown that the level of vascular endothelial growth factor (VEGF) usually increases locally and systemically after TACE treatment is performed, whereas sorafenib can inhibit the activity of VEGF receptors [11]. Thus, in recent years a large amount of studies have tried to combine sorafenib with TACE for patients with unresectable HCC, while the results were controversial [12]. Combination therapy may bring benefits for unresectable HCC patients in terms of TTP but not OS.…”