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Sorafenib use in elderly patients with hepatocellular carcinoma: caution about use of platelet aggregation inhibitors

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Abstract

Purpose

Sorafenib is the standard of care for advanced hepatocellular carcinoma (HCC). The peak incidence of HCC is around 70 years. We aimed to evaluate safety and efficacy of sorafenib in the elderly population.

Methods

We retrospectively reviewed data from patients treated with sorafenib for HCC at our institution. We compared safety and efficacy data across different age groups.

Results

Since 2005, 129 patients were treated, 78 (60.5 %) were <70 years old and 51 (39.5 %) were ≥70. The frequency of dose reduction was similar between the two groups (48.7 vs. 58.8 %), as was the occurrence of severe toxicities (41.0 vs. 51.0 %) and hospitalization due to toxicity (9.0 vs. 13.7 %). However, asthenia and bleeding were more frequent in the elderly. The higher frequency of bleeding was explained by concomitant antiplatelet treatments, and major asthenia was frequent in PS1 elderly patients. There was a trend toward less frequent interruption of treatment in the younger group (25.6 vs. 39.2 %) and significantly less frequent definitive discontinuation of treatment due to toxicity (24.4 vs. 45.1 %). Median progression-free survival was 5.6 months in both age groups, while median overall survival was 9.6 months in the younger age group and 12.6 months in the older age group.

Conclusion

Sorafenib showed similar results in terms of safety and efficacy in the elderly and younger HCC populations. Careful baseline evaluation is needed for patient’s selection in the elderly population, including discussion about antiplatelet therapy discontinuation and caution in PS1 patients, as well as active management of toxicity.

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References

  1. Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255. doi:10.1016/S0140-6736(11)61347-0

    Article  PubMed  Google Scholar 

  2. Nordenstedt H, White DL, El-Serag HB (2010) The changing pattern of epidemiology in hepatocellular carcinoma. Dig Liver Dis 42:S206–S214. doi:10.1016/S1590-8658(10)60507-5

    Article  PubMed Central  PubMed  Google Scholar 

  3. Cabibbo G, Maida M, Cammà C, Craxì A (2013) Is the efficacy of sorafenib treatment in patients with hepatocellular carcinoma affected by age? Expert Rev Anticancer Ther 13:1355–1361. doi:10.1586/14737140.2013.859989

    Article  CAS  PubMed  Google Scholar 

  4. Germano D, Tinessa V, Barletta E et al (2013) Targeted therapy for advanced hepatocellular cancer in the elderly: focus on sorafenib. Drugs Aging 30:887–892. doi:10.1007/s40266-013-0124-6

    Article  CAS  PubMed  Google Scholar 

  5. Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390

    Article  CAS  PubMed  Google Scholar 

  6. Morimoto M, Numata K, Kondo M et al (2011) Higher discontinuation and lower survival rates are likely in elderly Japanese patients with advanced hepatocellular carcinoma receiving sorafenib: sorafenib for elderly patients with HCC. Hepatol Res 41:296–302. doi:10.1111/j.1872-034X.2011.00778.x

    Article  CAS  PubMed  Google Scholar 

  7. Di Costanzo GG, Tortora R, De Luca M et al (2013) Impact of age on toxicity and efficacy of sorafenib-targeted therapy in cirrhotic patients with hepatocellular carcinoma. Med Oncol. doi:10.1007/s12032-012-0446-y

    PubMed  Google Scholar 

  8. Montella L, Addeo R, Cennamo G et al (2013) Sorafenib in elderly patients with advanced hepatocellular carcinoma: a case series. Oncology 84:265–272. doi:10.1159/000345558

    Article  CAS  PubMed  Google Scholar 

  9. Wong H, Tang YF, Yao T-J et al (2011) The outcomes and safety of single-agent sorafenib in the treatment of elderly patients with advanced hepatocellular carcinoma (HCC). Oncologist 16:1721–1728. doi:10.1634/theoncologist.2011-0192

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Francini E, Bianco V (2014) Tolerability of single-agent sorafenib in the treatment of elderly patients with hepatocellular carcinoma (HCC). Hepatol 60:764–765

    Article  CAS  Google Scholar 

  11. Jo M, Yasui K, Kirishima T et al (2014) Efficacy and safety of sorafenib in very elderly patients aged 80 years and older with advanced hepatocellular carcinoma. Hepatol Res. doi:10.1111/hepr.12308

    PubMed  Google Scholar 

  12. European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943. doi:10.1016/j.jhep.2011.12.001

    Google Scholar 

  13. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  14. Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60

    Article  CAS  PubMed  Google Scholar 

  15. Iavarone M, Cabibbo G, Piscaglia F et al (2011) Field-practice study of sorafenib therapy for hepatocellular carcinoma: a prospective multicenter study in Italy. Hepatology 54:2055–2063. doi:10.1002/hep.24644

    Article  CAS  PubMed  Google Scholar 

  16. Lencioni R, Kudo M, Ye S-L et al (2012) First interim analysis of the GIDEON (Global Investigation of therapeutic DEcisions in hepatocellular carcinoma and Of its treatment with sorafeNib) non-interventional study. Int J Clin Pract 66:675–683

    Article  CAS  PubMed  Google Scholar 

  17. Kim JE, Ryoo B-Y, Ryu M-H et al (2011) Sorafenib for hepatocellular carcinoma according to Child-Pugh class of liver function. Cancer Chemother Pharmacol 68:1285–1290. doi:10.1007/s00280-011-1616-x

    Article  CAS  PubMed  Google Scholar 

  18. Hamaker ME, Jonker JM, de Rooij SE et al (2012) Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 13:e437–e444. doi:10.1016/S1470-2045(12)70259-0

    Article  PubMed  Google Scholar 

  19. Bellera CA, Rainfray M, Mathoulin-Pélissier S et al (2012) Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 23:2166–2172. doi:10.1093/annonc/mdr587

    Article  CAS  PubMed  Google Scholar 

  20. Sattar S, Alibhai SMH, Wildiers H, Puts MTE (2014) How to implement a geriatric assessment in your clinical practice. Oncologist. doi:10.1634/theoncologist.2014-0180

    PubMed  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Medical Oncology Department, Centre Eugène Marquis, Av de la bataille Flandres Dunkerque, 35043, Rennes, France

    Julien Edeline, Laurence Crouzet, Samuel Le Sourd, Claire Larible, Angélique Brunot, Daniel Gédouin & Eveline Boucher

  2. Hepatology Department, CHU Pontchaillou, Rennes, France

    Florence Le Roy, Marianne Latournerie & Anne Guillygomarc’h

  3. Geriatry Department, CHU La Tauvrais, Rennes, France

    Catherine Cattenoz

  4. Unité de coordination en oncogériatrie Bretagne, Rennes, France

    Catherine Cattenoz & Daniel Gédouin

Authors
  1. Julien Edeline
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  2. Laurence Crouzet
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  3. Samuel Le Sourd
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  4. Claire Larible
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  5. Angélique Brunot
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  6. Florence Le Roy
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  7. Catherine Cattenoz
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  8. Marianne Latournerie
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  9. Daniel Gédouin
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  10. Anne Guillygomarc’h
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  11. Eveline Boucher
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Correspondence to Julien Edeline.

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Edeline, J., Crouzet, L., Le Sourd, S. et al. Sorafenib use in elderly patients with hepatocellular carcinoma: caution about use of platelet aggregation inhibitors. Cancer Chemother Pharmacol 75, 215–219 (2015). https://doi.org/10.1007/s00280-014-2645-z

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  • DOI: https://doi.org/10.1007/s00280-014-2645-z

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