Sorafenib With and Without Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombosis: A Retrospective Analysis

Abstract

Background. The survival benefit of combining sorafenib and transarterial chemoembolization (TACE) therapy compared with sorafenib monotherapy for patients with advanced hepatocellular carcinoma (HCC) and main portal vein tumor thrombosis (MPVTT) is unclear. Methods. Between January 2009 and June 2013, 183 consecutive patients with advanced HCC (Barcelona Clinic Liver Cancer stage C) and MPVTT were retrospectively reviewed. Of these, 89 patients with advanced HCC and MPVTT were enrolled in this study: 45 were treated with combination therapy (sorafenib‐TACE group), and the other 44 treated with sorafenib monotherapy (sorafenib group). Results. The mean number of TACE sessions per patient was 2.6 (range: 1–5). The median duration of sorafenib in the sorafenib‐TACE group and sorafenib group was 5.6 months and 5.4 months, respectively. The disease control rate was similar between the two groups. Median time to progression was 3.0 months (95% confidence interval [CI]: 2.2, 3.7) in the sorafenib‐TACE group, and 3.0 months (95% CI: 2.1, 3.8) in the sorafenib group (p = .924). Median overall survival was 7.0 months (95% CI: 6.1, 7.8) and 6.0 months (95% CI: 4.7, 7.3) in the sorafenib‐TACE group and the sorafenib group, respectively (p = .544). The adverse events related to sorafenib were comparable between the two groups. Twenty‐one adverse events of grade 3–4 related to TACE occurred in 12 patients (26.7%), and 2 of them died (4.4%). Conclusion. This study demonstrated no advantage of combination therapy over sorafenib monotherapy. Considering the patients’ morbidity after TACE, sorafenib monotherapy is appropriate for managing patients with advanced HCC and MPVTT. Implications for Practice: For patients with advanced hepatocellular carcinoma (HCC) and main portal vein tumor thrombosis (MPVTT), no benefit was seen in this study in terms of disease control rate, time to progression, and overall survival for patients receiving sorafenib and transarterial chemoembolization compared with those receiving sorafenib monotherapy. Considering the patients’ morbidity after combination therapy, monotherapy is appropriate for managing patients with advanced HCC and MPVTT.

Combined Transarterial Embolization/Chemoembolization-Based Locoregional Treatment with Sorafenib Prolongs the Survival in Patients with Advanced Hepatocellular Carcinoma and Preserved Liver Function: A Propensity Score Matching Study

“…Consistent with our study results, previous studies have reported that not only the presence of a portal vein invasion but also the extent of the portal vein invasion is crucial for determining the survival outcome of patients with BCLC grade C HCC [37,38]. In the study by Zhang et al [23], which included patients with HCC and main PVTT, TACE treatment combined with sorafenib resulted in a higher risk of liver decompensation. In their TACE-treated group, the ratio of newly developed ascites, hepatorenal syndrome, and liver dysfunction was high.…”

“…Zhang et al [23] included BCLC stage C HCC patients with main portal venous thrombosis and CTP class A/B liver function. They reported that TACE combined with sorafenib offered no additional benefit in terms of OS and TTP to sorafenib, and potential side effects were observed related to TACE in the combined treatment arm.…”

“…Bolondi et al [24] reported that a significantly different OS among BCLC B stage HCC patients was noted after stratifying treatment according to patients' liver function and tumor burden [25]. The results of Zhang et al [23] may, therefore, point out aggressive treatment can be deleterious in patients with limited liver function reserve and high tumor burden.…”

Transarterial chemoembolization (TACE) combined with sorafenib versus TACE for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

“…The median TTP in the combination group ranged from 3 to 7 months in five studies [10, 21, 23–25]. The median TTP in the TACE-alone group was 2.4 and 3.0 months in two studies [21, 23].…”

Hepatocellular Carcinoma with Macrovascular Invasion: Defining the Optimal Treatment Strategy

“…Zhang et al [41] retrospectively analyzed 45 patients treated with combination therapy and 45 patients treated with sorafenib monotherapy. Median overall survival was equivalent (7.0 and 6.0 months, respectively; p = 0.544).…”