Utilisation du sorafénib (Nexavar®) dans le traitement du carcinome hépatocellulaire : recommandations Prodige Afef

Boige, Valérie; Barbare, J.-C.; Rosmorduc, Olivier

doi:10.1016/j.gcb.2007.11.001

Cited by 25 publications

(14 citation statements)

References 3 publications

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“…The treatment was repeated every 2 weeks until disease progression or unacceptable toxicity. In patients with Child-Pugh A cirrhosis, the choice of giving GEMOX as a first-line palliative therapy was related to unavailability of sorafenib at the time of treatment, or to a multidisciplinary decision in patients with expected poor tolerance profile, according to the French recommendations for treatment of cancer [13,15]. …”

Section: Methodsmentioning

confidence: 99%

Feasibility of Gemcitabine plus Oxaliplatin in Advanced Hepatocellular Carcinoma Patients with Child-Pugh B Cirrhosis

Dhooge¹,

Mir

Perkins

et al. 2012

Oncology

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Purpose: Sorafenib improves survival in advanced hepatocellular carcinoma (HCC), but the demonstration of its efficacy and safety is limited to Child-Pugh A cirrhotic patients. The biweekly combination of gemcitabine and oxaliplatin (GEMOX) is safe and widely used in patients with advanced malignancies. We aimed to evaluate the feasibility of GEMOX in HCC patients with Child-Pugh B cirrhosis ineligible for sorafenib. Methods: The medical records of cirrhotic patients with advanced HCC receiving the GEMOX regimen between July 2006 and November 2011 were retrospectively reviewed. Treatment was repeated every 2 weeks until disease progression or unacceptable adverse effects occurred. The primary evaluation criterion was safety. Secondary evaluation criteria were the presence of muscle wasting (sarcopenia), response rate, progression-free survival and overall survival (OS). Results: Patients with Child-Pugh A (group A, n = 17) or Child-Pugh B cirrhosis (group B, n = 15) received a total of 169 cycles (median 4, range 1–16/patient). Eight patients in each group had sarcopenia. Common toxicities were thrombocytopenia (25 and 14 in groups A and B, respectively; p = 0.65) and peripheral neuropathy (44 and 54% in groups A and B, respectively; p = 1). Neither febrile neutropenia nor toxic death occurred. One patient in each group experienced grade 3 oesophageal varices bleeding. The response and disease control rates were 18% (95% CI 0–35.8) and 58.8% (95% CI 35.4–82.2) in group A, and 27% (95% CI 4.3–49.1) and 60.0% (95% CI 35.2–84.8) in group B. The median progression-free survival and OS did not differ between the two groups, but median OS was significantly shorter in sarcopenic patients. Conclusions: The GEMOX regimen appears feasible in HCC patients with Child-Pugh B cirrhosis and exerts anti-tumour activity. These data need to be confirmed in a prospective study.

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Section: Methodsmentioning

confidence: 99%

Feasibility of Gemcitabine plus Oxaliplatin in Advanced Hepatocellular Carcinoma Patients with Child-Pugh B Cirrhosis

Dhooge¹,

Mir

Perkins

et al. 2012

Oncology

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“…In principle, indications for the use of sorafenib should be limited to the inclusion criteria used in the Sharp study [56]: • for HCC, which is not considered amenable to curative surgery (transplantation, hepatectomy, percutaneous ablation, chemo-embolization); • use restricted to patients with intact hepatic function:…”

Section: How and For Which Patients Should These Medications Be Used?mentioning

confidence: 99%

“…Some experts feel that therapy should not be interrupted simply because of radiologic evidence of tumor progression so long as there is no symptomatic worsening. But opinion is divided on this question; other experts feel Sorafenib should be stopped if there is clear evidence of tumor progression Table 1 Contraindications to the use of sorafenib in the treatment of hepatocellular carcinoma (taken from the exclusion criteria of the Sharp study [56]). …”

Section: How and For Which Patients Should These Medications Be Used?mentioning

confidence: 99%

“…Age < 18 years Coronary insufficiency, unstable angina, recent acute MI (within 6 months) Congestive heart failure ≥Stage II Hypertension or cardiac arrhythmia uncontrolled by medical therapy Severe peripheral arterial occlusive disease Severe infection Gastrointestinal hemorrhage within the last month Serum creatinine 1.5 times the upper limit of normal Hemoglobin <8.5 g/dl Platelet count <60,000/l Albumin <2.8 g/dl Total bilirubin >5 mol/dl INR >2.5 Inability to take medications by mouth Pregnancy or actively nursing mother [56]. Rules for adjusting medication dosage are laid out in Table 2.…”

Section: How and For Which Patients Should These Medications Be Used?mentioning

confidence: 99%

“…Just as for any other decision regarding cancer therapy, the choice of sorafenib therapy should be concerted by a multi-disciplinary tumor conference; because of the unique nature of HCC, such a conference should include an oncologist, a hepatologist or experienced gastroenterologist, an hepatic surgeon and a radiologist with expertise in HCC [56].…”

Section: Who Should Oversee This Therapy?mentioning

confidence: 99%

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Hepatocellular carcinoma – what's new?

Vullierme

Paradis

Chirica

et al. 2010

Journal of Visceral Surgery

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The increasing incidence of hepatocellular carcinoma (HCC) has led several countries to standardize and update its management. This review aims at summarizing these evolutions through six questions focusing on diagnosis and treatment. The radiological diagnosis of this tumor has been refined. Besides being hypervascular at the arterial phase, the "washout" in particular at the late phase of injection has become a prominent feature. Although routine ultrasound remains the corner stone of screening, contrast ultrasound has become a very reliable characterization tool as it allows continuous monitoring of the vascular kinetics. Biopsy of the tumor allows identification of conventional or molecular prognosis features, some of which could be used in current practice. The metabolic syndrome is an increasing etiology of HCC and carcinogenesis in this context may not always require the development of formal underlying cirrhosis. Associated (in particular cardiovascular) conditions account for an increased morbidity-mortality following surgery. Liver transplantation is the most effective treatment of early-stage tumors. The limited availability of grafts has led some countries including France to implement new allocation rules that are still evaluated and might need to be refined. Sorafenib is the first medical treatment shown to be effective in the treatment of HCC. This efficacy is however still limited and its indication is therefore restricted to Child-Pugh A, OMS 0-2 patients in whom a potentially curative treatment is contraindicated.

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Place des thérapies ciblées dans le traitement du carcinome hépatocellulaire

Rosmorduc

2011

Post’U FMC-HGE

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Utilisation du sorafénib (Nexavar®) dans le traitement du carcinome hépatocellulaire : recommandations Prodige Afef

Cited by 25 publications

References 3 publications

Feasibility of Gemcitabine plus Oxaliplatin in Advanced Hepatocellular Carcinoma Patients with Child-Pugh B Cirrhosis

Feasibility of Gemcitabine plus Oxaliplatin in Advanced Hepatocellular Carcinoma Patients with Child-Pugh B Cirrhosis

Hepatocellular carcinoma – what's new?

Place des thérapies ciblées dans le traitement du carcinome hépatocellulaire

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