Long-term therapy with sorafenib is associated with pancreatic atrophy

• Published in: The Journal of surgical research 2015-12, Vol.199 (2), p.314-321
• Main Authors: Xu, Li, MD, Zhou, Dong-Sheng, MD, Zhao, Jing, MD, Spolverato, Gaya, MD, Zhang, Yao-Jun, MD, Li, Sheng-Ping, MD, PhD, Chen, Min-Shan, MD, PhD, Pawlik, Timothy M., MD, MPH, PhD
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Atrophy - chemically induced; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - mortality; China - epidemiology; Cohort Studies; Female; Hepatocellular carcinoma; Humans; Late toxicity; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Male; Middle Aged; Niacinamide - administration & dosage; Niacinamide - adverse effects; Niacinamide - analogs & derivatives; Pancreas - pathology; Pancreatic atrophy; Pancreatic Diseases - chemically induced; Pancreatic Diseases - pathology; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - adverse effects; Sorafenib; Surgery; Treatment Outcome
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2015.04.035

Abstract Background Although the short-term adverse effects of sorafenib are well known, few data exist on long-term toxicity. The objective of the present study was to investigate the prevalence of pancreatic atrophy among a cohort of patients with hepatocellular carcinoma (HCC) who were treated with sorafenib for ≥2 y. Methods Between March 2007 and December 2013, 31 patients with HCC who were treated with sorafenib for ≥2 y were identified. The effect of pancreatic atrophy and enhancement on incidence of adverse events, tumor response, and overall survival (OS) were assessed. Results Thirty-one patients with HCC were treated with sorafenib for ≥2 y and met inclusion criteria; 11 patients (35.5%) were Barcelona-clinic liver cancer stage B, whereas 20 patients (64.5%) were Barcelona-clinic liver cancer stage C. Median duration of treatment with sorafenib was 35.2 mo. Pancreatic atrophy and a decrease in pancreatic enhancement occurred in 24 patients (77.4%) and 15 patients (48.4%), respectively. On the basis of the modified response evaluation criteria in solid tumors, four patients (12.9%) had a complete response, 10 patients (32.3%) had a partial response, and 17 patients (54.8%) had stable disease. Patients treated with sorafenib with pancreatic atrophy had a median OS of 49.4 mo (95% confidence interval, 41.2–57.5 mo) compared with 31.2 mo (95% confidence interval, 25.7–36.7 mo) among patients who did not develop pancreatic atrophy ( P  = 0.009). In contrast, survival was not associated with decreased versus normal enhancement of the pancreas (OS, 47.7 mo versus 41.7 mo, respectively; P  = 0.739). Conclusions Pancreatic atrophy occurred in many HCC patients after 2 y of treatment with sorafenib. Patients who experienced pancreatic atrophy had a better tumor response and OS.