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Prognostic factors of sorafenib therapy in hepatocellular carcinoma patients with failure of transarterial chemoembolization

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Abstract

Background

There is no approved therapy for patients with failed transarterial chemoembolization (TACE) and progression of hepatocellular carcinoma. We aimed to investigate the efficacy and prognostic factors in patients with TACE failure who received sorafenib rescue therapy.

Methods

We investigated 54 patients who met the criteria of TACE failure as defined by the international guidelines of Europe and Japan. Sorafenib was used as a rescue therapy. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier methods, and multivariate analysis was performed to find prognostic factors.

Results

The patients were followed for a median 5.5 months, and the median duration of sorafenib administration was 3.3 months. The presence of main (or lobar) portal vein invasion (PVI) (3.7 versus 8.4 months, p = 0.004), dose reduction of sorafenib (4.0 versus 8.8 months, p = 0.002) and Child-Pugh class B (5.3 versus 8.9 months, p = 0.004) were associated with shorter OS compared to the presence of segmental PVI (or absence of macroscopic vascular invasion, MVI), full dosage of sorafenib and Child-Pugh class A, respectively. The presence of main (or lobar) PVI was associated with poorer PFS compared to the presence of segmental PVI (or absence of MVI) (2.1 versus 3.8 months p = 0.010).

Conclusions

Sorafenib is a potential rescue therapy in patients with TACE failure. However, the clinical benefits need to be further evaluated for patients with main (or lobar) PVI or those treated with reduced doses of sorafenib.

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Abbreviations

HCC:

Hepatocellular carcinoma

OS:

Overall survival

TACE:

Transarterial chemoembolization

AFP:

Alpha-fetoprotein

BCLC:

Barcelona clinic liver cancer

ECOG PS:

Eastern Cooperative Oncology Group performance status

AP:

Arterioportal

EHS:

Extrahepatic spreading

PVI:

Portal vein invasion

MVI:

Macroscopic vascular invasion

CT:

Computed tomography

MRI:

Magnetic resonance imaging

mRECIST:

Modified response evaluation criteria in solid tumors

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progression disease

PFS:

Progression-free survival

HR:

Hazard ratio

CI:

Confidence interval

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Author contribution statement

Do Young Kim and Sangheun Lee participated in the study conception and design. Each author worked on the following tasks: Sangheun Lee, Do Young Kim and Jung Hyun Kang wrote the manuscript. Sang Hoon Ahn and Jun Yong Park collected data and corrected the manuscript. Seung Up Kim and Beom Kyung Kim collected data and participated in study design. Kwang-Hyub Han critically reviewed the manuscript. All authors reviewed and approved the final version of the manuscript to be published.

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    Authors and Affiliations

    1. Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea

      Sangheun Lee

    2. Institute for Integrative Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea

      Sangheun Lee

    3. Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

      Jung Hyun Kang, Do Young Kim, Sang Hoon Ahn, Jun Yong Park, Beom Kyung Kim, Seung Up Kim & Kwang-Hyub Han

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    1. Sangheun Lee
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    Correspondence to Do Young Kim.

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    Conflict of interest

    Sangheun Lee, Jung Hyun Kang, Do Young Kim, Sang Hoon Ahn, Jun Yong Park, Beom Kyung Kim, Seung Up Kim and Kwang-Hyub Han declare that they have no conflict of interest.

    Ethical approval

    This study was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was obtained from each participant or responsible family member after possible complications of the diagnostic procedures and anti-cancer treatments had been fully explained. This study was approved by the independent institutional review board of Severance Hospital.

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    S. Lee and J. H. Kang have equally contributed to this work.

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    Lee, S., Kang, J.H., Kim, D.Y. et al. Prognostic factors of sorafenib therapy in hepatocellular carcinoma patients with failure of transarterial chemoembolization. Hepatol Int 11, 292–299 (2017). https://doi.org/10.1007/s12072-017-9792-3

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    • DOI: https://doi.org/10.1007/s12072-017-9792-3

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