Sorafenib combined with embolization plus hepatic arterial infusion chemotherapy for inoperable hepatocellular carcinoma

Abstract

BACKGROUND There is little evidence of combining sorafenib with hepatic arterial infusion chemotherapy (HAIC) after transarterial chemoembolization (TACE) for intermediate and advanced hepatocellular carcinoma (HCC). It is important to identify that patients with intermediate and advanced HCC are most likely to benefit from this combination therapy. AIM To investigate the safety and clinical outcomes of sorafenib combined with HAIC with folinic acid, 5-fluorouracil (5-FU), and oxaliplatin (FOLFOX) after TACE for intermediate and advanced HCC. METHODS This prospective phase II study enrolled patients with intermediate and advanced HCC who underwent treatment with sorafenib combined with TACE-HAIC. All patients initially received the standard 400 mg dose of sorafenib twice daily before TACE-HAIC. Participants at our institute with intermediate and advanced HCC underwent routine TACE. Then, the catheter used for embolization was kept in place in the hepatic artery, and oxaliplatin was intra-arterially administered for 6 h, followed by 5-FU for 18 h, and folinic acid was intravenously administered for 2 h. The primary endpoints were safety, as evaluated by the Common Terminology and Criteria for Adverse Events version 4.0, and 12-mo progression-free survival (PFS), as analyzed by the Kaplan-Meier method. As secondary endpoints, the objective response rate (ORR) was evaluated by the modified Response Evaluation Criteria for Solid Tumors, and survival time [overall survival (OS)] was analyzed by the Kaplan-Meier method. RESULTS Sixty-six participants at our institute with intermediate and advanced HCC were enrolled in this prospective study (mean age, 53.3 ± 11.7 years). Approximately 56.1% of participants had Barcelona Clinic Liver Cancer (BCLC) stage C disease, and 43.9% had BCLC stage B disease. The ORR was 42.4%. The disease control rate was 87.9%. The grade 3-4 toxicities consisted of thrombocytopenia (4.5%), neutropenia (3.0%), and elevated aspartate aminotransferase (12.2%). Hand-foot skin reaction was also observed (40.9%). The median PFS was 13.1 mo (13.5 mo in the BCLC stage B participants and 9.4 mo in the BCLC stage C participants). The 6-mo, 12-mo, and 24-mo PFS rates were 75.0%, 54.7%, and 30.0%, respectively. The median OS was 21.8 mo. CONCLUSION Sorafenib combined with HAIC (FOLFOX) after TACE may be a feasible treatment choice for intermediate and advanced HCC because this treatment met the prespecified endpoint of a 6-mo PFS rate exceeding 50% and had good patient tolerance. Prospective randomized controlled trials are needed to confirm the effect of this combination therapy.

Infiltrative Hepatocellular Carcinoma: Transcatheter Arterial Chemoembolization Versus Hepatic Arterial Infusion Chemotherapy

“…FOLFOX using oxaliplatin instead of cisplatin is a combined and classic anticancer method and proved to be effective systemically for advanced HCC. Moreover, the well-received advantage of HAIC is a lower incidence of AEs and major complications compared with systemic chemotherapy and TKIs ( 29 , 30 ). The incidence of grade 1-2 (42.4%) and 3-4 AEs (2.1%) were found in our study.…”

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

“…31,34 The combination of HAIC with RT has also been reported to significantly prolong OS and PFS better as compared to sorafenib alone among HCC with VP4 PVTT (median, 9.9 versus 5.3, and 3.9 versus 1.9 months). 121 Recently combining HAIC with TACE and Sorafenib proved to be a safe and better treatment option for patients with PVTT, 122 while addition of anti-PD-1 immunotherapy was reported to improve the efficacy of HAIC in advanced HCC 123 (Table 3).…”

HCC and Molecular Targeting Therapies: Back to the Future

“…Wang et al demonstrated that sorafenib, as an adjuvant therapy for liver cancer, can prevent early recurrence after hepatectomy [55,56]. In phase II studies, hepatic arterial infusion chemotherapy plus sorafenib showed favorable cancer control and a manageable safety profile, although in phase III studies it may have produced conflicting results [57]. However, sorafenib was found to be ineffective as an adjuvant treatment after curative resection or as a concomitant treatment with TACE [58][59][60].…”