Sorafenib Combined with Transarterial Chemoembolization versus Transarterial Chemoembolization Alone for Advanced-Stage Hepatocellular Carcinoma: A Propensity Score Matching Study

Abstract

AimsThe purpose of the present study was to compare the efficacies of transarterial chemoembolization (TACE) combined with sorafenib versus TACE monotherapy for treating patients with advanced hepatocellular carcinoma (HCC).MethodsWe enrolled 321 patients and selected 280 with advanced HCC (Barcelona Clinic Liver Cancer stage C) who underwent TACE therapy between February 2009 and February 2013. TACE alone (monotherapy group) was administered to 198 patients (70.7%), and the remaining 82 (29.3%) underwent repeat combined TACE and sorafenib therapy (combined group). To minimize selection bias, these latter 82 patients were matched using propensity-score matching at a 1∶2 ratio with 164 patients who received TACE monotherapy. The primary endpoints were overall survival (OS) and related subgroup analysis. The secondary endpoints were time to progression (TTP) and treatment-related adverse events.ResultsOf the respective patients in the combined and monotherapy groups, 64.6% and 49.2% had vascular invasion, 87.8% and 91.1% had extrahepatic metastasis, and 54.3% and 47.1% had both. In the propensity-score–matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003). The TTP was significantly longer in the combined group (2.6 months vs. 1.9 months, respectively, P = 0.001). Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05). Univariate and subsequent multivariate analyses revealed that the addition of sorafenib was an independent predictor of favorable OS and TTP (adjusted hazard ratios, 0.63 and 0.62, respectively; P<0.05 for both).ConclusionSorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion. Future trials with larger samples are required to validate these preliminary findings.

Current management of hepatocellular carcinoma: An Eastern perspective

“…Another study compared the efficacy of TACE plus sorafenib and TACE alone in 246 advanced stage HCC patients (82 and 164 patients, respectively) after propensity score matching. Overall survival was significantly longer in the combination group than in the TACE monotherapy group (7.0 and 4.9 mo, respectively; P = 0.003) as was time to progression (2.6 and 1.9 mo, respectively; P = 0.001) [150] . These data suggest that the combination of TACE and sorafenib is most likely more efficacious than either therapy alone in advanced HCC.…”

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.…”

Sorafenib-based regimens in the management of unresectable hepatocellular carcinoma: an updated meta-analysis of randomized controlled trials

“…After extracting duplicates, 798 manuscripts remained, of which most were deemed irrelevant based on their title or/and abstract . Of the remaining 14 studies, four were not RCTs [14,15,25,26], two compared sorafenib with chemotherapeutic drugs [16,27], and two were subgroup analysis of prior clinical trials [12,28]. Ultimately, six studies were included in our analysis [8][9][10][11]13,29] (Figure 3).…”