Efficacy of Transcatheter Arterial Chemoembolization Followed by Sorafenib for Intermediate/Advanced Hepatocellular Carcinoma in Patients in Japan: A Retrospective Analysis

Abstract

BackgroundSorafenib might prevent hepatocellular carcinoma (HCC) recurrence caused by the promotion of neoangiogenesis after transarterial chemoembolization (TACE).ObjectivesTo evaluate the efficacy and safety of TACE followed by sorafenib for treating advanced HCC.Patients and MethodsWe retrospectively analyzed 95 advanced HCC patients treated with TACE between July 2008 and December 2012 at our institution. Twenty-four patients received TACE followed by sorafenib within 14 days (S-TACE) and 71 received TACE alone. Progression-free survival (PFS) and cumulative survival from the time of non-responsiveness to TACE were compared between groups and predictive factors for PFS were analyzed.ResultsThe median patient age was 72.2 years and 74 patients were male (77.9 %). Although median tumor size was similar between groups, the mean tumor number was significantly higher in the S-TACE versus TACE-alone group (16 vs. 8, P = 0.04). The number of prior treatments was significantly higher in the S-TACE group. Other baseline variables were similar. There were two severe adverse events in the S-TACE group and none in the TACE-alone group. Median PFS (189 vs. 106 days, P = 0.02) and median overall survival time (861 vs. 467 days, P = 0.01) from the time of non-responsiveness to TACE were significantly longer with S-TACE than TACE alone. Adjusting for significant factors in univariate analysis, multivariate analysis indicated that sorafenib administration, tumor size, and alanine transaminase were independent predictors of PFS.ConclusionTACE followed by sorafenib significantly improved PFS and survival in patients with advanced HCC unresponsive to TACE.

Transarterial chemoembolization plus sorafenib for the management of unresectable hepatocellular carcinoma: a systematic review and meta-analysis

“…Many clinical trials also have shown that combination therapy can prolong OS [4, 6, 11–13]. The heterogeneity of patients’ physical conditions may be the primary factor affecting OS, as candidate selection may make a difference.…”

Efficacy and safety of TACE in combination with sorafenib for the treatment of TACE-refractory advanced hepatocellular carcinoma in Chinese patients: a retrospective study

“…These findings were further supported by two meta-analyses of randomized controlled trials, published by Zhang et al21 and Fu et al9 Moreover, SOR also showed significantly improved OS and TTP in patients with intermediate or advanced HCC that is refractory to TACE 10,22,23…”

“…A previously published case series reported the beneficial effects of SOR for the treatment of TACE-refractory HCC 10. In addition, a retrospective study showed that the DCR for SOR was 60.4%, the median TTP was 3.9 months, and the median OS was 16.4 months in patients who were refractory to TACE 22.…”

“…Recently published studies have shown that TACE combined with SOR is superior to TACE or SOR monotherapy in prolonging overall survival (OS) and time to progression (TTP) in patients with advanced HCC 9,10,19,20. These findings were further supported by two meta-analyses of randomized controlled trials, published by Zhang et al21 and Fu et al9 Moreover, SOR also showed significantly improved OS and TTP in patients with intermediate or advanced HCC that is refractory to TACE 10,22,23…”

Management of advanced hepatocellular carcinoma: review of current and potential therapies

“…Several studies compared sorafenib plus TACE to sorafenib or TACE [72][73][74][75][76][77][78] [Supplementary Table 4]. A meta-analysis of sorafenib in combination with TACE that included data of 1,254 patients found that the combination improved OS and TTP in advanced HCC, but not PFS, with higher rate of severe adverse reaction in the combination group.…”