The safety and efficacy of transarterial chemoembolization combined with sorafenib and sorafenib mono-therapy in patients with BCLC stage B/C hepatocellular carcinoma

• Published in: BMC cancer 2017-09, Vol.17 (1), p.645-645, Article 645
• Main Authors: Wu, Fei-Xiang, Chen, Jie, Bai, Tao, Zhu, Shao-Liang, Yang, Tian-Bo, Qi, Lu-Nan, Zou, Ling, Li, Zi-Hui, Ye, Jia-Zhou, Li, Le-Qun
• Format: Article
• Language: English
• Subjects: Adult; Adverse events; Aged; Antineoplastic agents; Blood clots; Blood platelets; Cancer therapies; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - pathology; Care and treatment; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Combined Modality Therapy; Complications and side effects; Diagnosis; Disease-Free Survival; Dosage and administration; Drug dosages; Drug-Related Side Effects and Adverse Reactions - classification; Drug-Related Side Effects and Adverse Reactions - pathology; Female; Gangrene; Hepatitis B Surface Antigens - blood; Hepatocellular carcinoma; Humans; Liver cancer; Liver Neoplasms - blood; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Male; Medical prognosis; Middle Aged; Neoplasm Staging; Niacinamide - administration & dosage; Niacinamide - adverse effects; Niacinamide - analogs & derivatives; NMR; Nuclear magnetic resonance; Patients; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - adverse effects; Portal vein tumor thrombus; Prognosis; Sorafenib; Studies; Surgery; Survival; Targeted cancer therapy; Thrombosis; Transarterial chemoembolization; Treatment Outcome; Vascular endothelial growth factor; Veins & arteries
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-017-3545-5

Sorafenib and transarterial chemoembolization (TACE) are recommended therapies for advanced hepatocellular carcinoma (HCC), but their combined efficacy remains unclear. Between August 2004 and November 2014, 104 patients with BCLC stage B/C HCC were enrolled at the Affiliated Tumor Hospital of Guangxi Medical University, China. Forty-eight patients were treated with sorafenib alone (sorafenib group) and 56 with TACE plus sorafenib (TACE + sorafenib group). Baseline demographic/clinical data were collected. The primary outcomes were median overall survival (OS) and progression-free survival (PFS). Secondary outcomes were overall response rate (ORR) and sorafenib-related adverse events (AEs). Baseline characteristics associated with disease prognosis were identified using multivariate Cox hazards regression. The mean age of the 104 patients (94 males; 90.38%) was 49.02 ± 12.29 years. Of the baseline data, only albumin level (P = 0.028) and Child-Pugh class (P = 0.017) differed significantly between groups. Median OS did not differ significantly between the sorafenib and TACE + sorafenib groups (18.0 vs. 22.0 months, P = 0.223). Median PFS was significantly shorter in the sorafenib group than that in the TACE + sorafenib group (6.0 vs. 8.0 months, P = 0.004). Six months after treatments, the ORRs were similar between the sorafenib and TACE + sorafenib groups (12.50% vs. 18.75%, P = 0.425). The rates of grade III-IV adverse events in sorafenib and TACE + sorafenib groups were 29.2% vs. 23.2%, respectively. TACE plus sorafenib treatment (HR = 0.498, 95% CI = 0.278-0.892), no vascular invasion (HR = 0.354, 95% CI = 0.183-0.685) and Child-Pugh class A (HR = 0.308, 95% CI = 0.141-0.674) were significantly associated with better OS, while a larger tumor number was predictive of poorer OS (HR = 1.286, 95% CI = 1.031-1.604). TACE plus sorafenib treatment (HR = 0.461, 95% CI = 0.273-0.780) and no vascular invasion (HR = 0.557, 95% CI = 0.314-0.988) were significantly associated with better PFS. Compared with sorafenib alone, combining TACE with sorafenib might prolong survival and delay disease progression in patients with advanced HCC.