Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma

Abstract

BackgroundAlthough sorafenib is considered standard therapy for advanced hepatocellular carcinoma (HCC), actual treatments vary. We evaluated the effects of different treatment strategies on overall survival.MethodsA retrospective study of sorafenib-treated patients with advanced HCC was conducted. The primary outcome was overall survival. Prognostic factors were analyzed using multivariate Cox-proportional hazards model.ResultsA total of 658 patients (mean age, 54.5 years; 83.3% male) were analyzed; 293, 129, and 236 patients were treated with sorafenib, a combination therapy of sorafenib and transarterial chemoembolization (TACE), and TACE followed by sorafenib, respectively. Overall, 51.2% of patients treated under the combination strategy had portal vein invasion, whereas 89.9% of patients receiving sorafenib monotherapy had distant metastasis. Median overall survival durations were comparable (11.8 months for sorafenib, 16.2 months for the combination therapy, and 13.5 months for TACE followed by sorafenib; P = 0.13). However, among portal vein invasion cases, combination (25.7 months, P = 0.002) and TACE followed by sorafenib (14.0 months, P = 0.030) treatments were associated with longer overall survival duration compared with than sorafenib monotherapy (5.5 months). In a multivariate model, sorafenib duration (hazard ratio [HR], 0.96, P < 0.001) and TACE (HR, 0.24, P < 0.001) along with Child-Pugh stage (HR, 1.83, P = 0.005) were associated with better survival.ConclusionsIn patients with portal vein invasion, TACE performed concurrently with or before sorafenib administration is associated with better survival.

Phase II Studies with Refametinib or Refametinib plus Sorafenib in Patients with RAS-Mutated Hepatocellular Carcinoma

“…Compared with the known safety profile of sorafenib monotherapy (29,35), a higher incidence of liver and gastrointestinal toxicities and rash was observed in patients who received refametinib plus sorafenib. However, alopecia and hand-foot skin reaction were less common compared with those reported for sorafenib monotherapy (14% vs. 12.5% and 21% vs. 6.3%, respectively; ref.…”

Role of locoregional therapies in the wake of systemic therapy

“…On subgroup analysis they identified that patients with portal invasion benefited significantly from the combination (median OS for sorafenib monotherapy 5.5 months; for c-TACE followed by sorafenib 14.0 months, p = 0.030; for the combination 25.7 months, p = 0.002). 45 Given the potential risks of TACE in the setting of PVT and its strongly adverse prognostic effect, further investigations of TACE combinations in this context should proceed with caution. These risks are reflected by the contrary results from a single-centre retrospective study of 89 patients with main portal vein tumour thrombosis (PVTT) 46 in which no survival difference was evident and median survival was only 6 to 7 months.…”

Hepatocellular Carcinoma with Macrovascular Invasion: Defining the Optimal Treatment Strategy

“…Median overall survival was equivalent (7.0 and 6.0 months, respectively; p = 0.544). Ha et al [42] conducted a retrospective study including 658 patients with advanced HCC. Among the 257 patients with portal vein invasion, survivals with combination therapy (TACE plus sorafenib; 25.7 months) and TACE followed by sorafenib (14.0 months) were significantly longer than that with sorafenib monotherapy (5.5 months), regardless of the metastatic status at the time of sorafenib initiation.…”