Fever within 2 Weeks of Sorafenib Therapy Predicts Favorable Treatment Efficacy in Patients with Advanced Hepatocellular Carcinoma

Abstract

Objectives: The aim of this study was to investigate the relationship between fever within 2 weeks after the start of sorafenib therapy and treatment efficacy in patients with advanced hepatocellular carcinoma (HCC). Methods: One hundred and two patients with advanced HCC were enrolled in this study. We retrospectively compared patients with fever (more than 38°C) within 2 weeks after the start of sorafenib therapy (fever group, n = 34) and patients without fever (non-fever group, n = 68) in terms of survival, best antitumor response, and change in intratumor blood on contrast-enhanced computed tomography (CE-CT) after 2 weeks of sorafenib therapy. Results: Fever was the only significant and independent predictor of better outcomes (hazard ratio, 0.517; 95% confidence interval, 0.319-0.838; p = 0.0071). In the fever group, the partial response rate, the disease control rate, and the rate of disappearance of arterial tumor enhancement on CE-CT after 2 weeks of sorafenib therapy were significantly higher than those in the non-fever group (38.2 vs. 5.9%, respectively, p = 0.0001; 85.3 vs. 60.3%, respectively, p = 0.0103; 76.5 vs. 35.3%, respectively, p < 0.0001). Conclusions: Fever within 2 weeks after the start of sorafenib therapy may be a useful predictor of a favorable treatment response in patients with advanced HCC.

Clinical features of lenvatinib for unresectable hepatocellular carcinoma in real‐world conditions: Multicenter analysis

“…Thus, a decline of log10 AFP from the baseline within the first 4 weeks might also have predictive value for therapeutic response in patients receiving LEN treatment. In addition, a previous study noted that fever within 2 weeks after the start of SOR therapy may be useful as a predictor of favorable treatment response in patients with advanced HCC and receiving SOR treatment . Three of our patients developed a fever within 2 weeks after the start of LEN (grade 1, 2, 3: each 1 patient), in whom therapeutic response was PD in 2 and SD in 1.…”

Clinical characteristics and outcomes of candidates for second‐line therapy, including regorafenib and ramucirumab, for advanced hepatocellular carcinoma after sorafenib treatment

“…The starting dose of sorafenib (Nexavar; Bayer Yakuhin, Osaka, Japan) was 800 mg/day given orally. However, because of the possibility of having to discontinue sorafenib treatment at an early stage due to adverse events (AE), the initial dose was set to 400 mg/day in patients who were 80 years or older, had a body weight of 50 kg or less, had poor renal function, or had a history of treatment for varices or ascites …”

“…Four‐phase (i.e. unenhanced, late arterial, portal venous, and equilibrium) CE‐CT examination was carried out at baseline, at 6 weeks after sorafenib treatment with a predetermined schedule, and every 4–10 weeks thereafter . Radiologic antitumor response was first assessed at 6 weeks.…”

Prognostic Factors Associated with Postprogression Survival in Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib Not Eligible for Second-Line Regorafenib Treatment

“…Four-phase (i.e., unenhanced, late arterial, portal venous, and equilibrium phase) CE-CT examination was performed at baseline, 6 weeks after sorafenib administration with predetermined scheduling, and every 4–10 weeks thereafter [16]. The first radiological antitumor response was assessed at 6 weeks, and the second radiological antitumor response was assessed within 4 months after the start of sorafenib therapy.…”

“…However, out of concern for the possibility of having to discontinue sorafenib treatment at an early stage due to adverse events, the initial dose was set to 400 mg/day in patients who were 80 years or older, had a body weight of 50 kg or less, had poor renal function, and had a history of treatment for varices or ascites [16-18]. Sorafenib therapy was continued until the occurrence of potentially fatal adverse events or until clinical tumor progression.…”