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Cancer Chemotherapy and Pharmacology

, Volume 82, Issue 3, pp 469–478 | Cite as

Randomized, prospective, comparative study on the effects and safety of sorafenib vs. hepatic arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein tumor thrombosis

  • Jong Hwan Choi
  • Woo Jin ChungEmail author
  • Si Hyun BaeEmail author
  • Do Seon Song
  • Myeong Jun Song
  • Young Seok Kim
  • Hyung Joon Yim
  • Young Kul Jung
  • Sang Jun Suh
  • Jun Yong Park
  • Do Young Kim
  • Seung Up Kim
  • Sung Bum Cho
Original Article

Abstract

Background/aims

Treatment responses of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remain unacceptably low and treatment modalities are limited. We compared the efficacy and safety of sorafenib and hepatic arterial infusion chemotherapy (HAIC).

Methods

In this randomized, prospective, comparative study, data on 58 patients with advanced HCC with PVTT, with Child–Turcotte–Pugh (CTP) scores of 5–7, were collected from six university hospitals between January 2013 and October 2015. Twenty-nine patients were treated with sorafenib and twenty-nine with HAIC.

Results

The median overall survival (OS) and time to progression (TTP) were significantly longer in the HAIC group than in the sorafenib group (14.9 vs.7.2 months, p = 0.012 and 4.4 vs. 2.7 months, p = 0.010). The objective response (OR) rates were 27.6 and 3.4% in the HAIC and sorafenib groups, respectively (p = 0.001). In univariate analysis, sex, main portal vein invasion and treatment modality were significant prognostic factors of OS (p = 0.044, 0.040, 0.015), whereas cause of HCC, tumor number, tumor location and treatment modality were significant prognostic factors of TTP (p = 0.040, 0.002, 0.034, 0.014). In multivariate analysis, sex and treatment modality were significant prognostic factors of OS (p = 0.008, 0.005), whereas cause of HCC, tumor number, tumor location and treatment modality were significant prognostic factors of TTP (p = 0.038, 0.038, 0.015, 0.011). Major complications included hyperbilirubinemia (44.8%), AST elevation (34.5%), ascites (13.8%) and catheter-related complications (3.4%) in the HAIC group and hyperbilirubinemia (34.5%), hand-foot syndrome (31.0%) and AST elevation (27.6%) in the sorafenib group.

Conclusions

For managing advanced HCC with PVTT, HAIC may be a valuable treatment modality.

Keywords

Hepatocellular carcinoma Portal vein tumor thrombosis Sorafenib Hepatic arterial infusion chemotherapy Prognosis 

Abbreviations

HCC

Hepatocellular carcinoma

PVTT

Portal vein tumor thrombosis

HAIC

Hepatic arterial infusion chemotherapy

CTP

Child–Turcotte–Pugh

HBV

Hepatitis B virus

HCV

Hepatitis C virus

mUICC

Modified Union for International Cancer Control

AFP

Alphafetoprotein

ECOG

Eastern Cooperative Oncology Group

ANC

Absolute neutrophil count

OS

Overall survival

TTP

Time to progression

OR

Objective response

BCLC

Barcelona Clinic Liver Cancer

EASL

European Association for the Study of Liver

CT

Computed tomography

MRI

Magnetic resonance imaging

mRECIST

Modified Response Evaluation Criteria in Solid Tumors

AST

Aspartate transaminase

ALT

Alanine aminotransferase

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jong Hwan Choi
    • 1
  • Woo Jin Chung
    • 1
    Email author
  • Si Hyun Bae
    • 2
    Email author
  • Do Seon Song
    • 2
  • Myeong Jun Song
    • 2
  • Young Seok Kim
    • 3
  • Hyung Joon Yim
    • 4
  • Young Kul Jung
    • 4
  • Sang Jun Suh
    • 4
  • Jun Yong Park
    • 5
  • Do Young Kim
    • 5
  • Seung Up Kim
    • 5
  • Sung Bum Cho
    • 6
  1. 1.Department of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
  2. 2.Department of Internal Medicine, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  3. 3.Department of Internal MedicineSoonchunhyang University Bucheon HospitalBucheonRepublic of Korea
  4. 4.Department of Internal MedicineKorea University Ansan HospitalAnsanRepublic of Korea
  5. 5.Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  6. 6.Department of Internal MedicineChonnam National University Medical SchoolGwangjuRepublic of Korea

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