8:32 AM Abstract No. 132 - Transarterial chemoembolization combined with sorafenib for advanced hepatocellular carcinoma with portal vein tumor thrombus: A prospective control study

Abstract

Purpose To assess the efficacy and safety of transarterial chemoembolization (TACE) combined with sorafenib for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Materials and Methods 106 patients with advanced HCC were enrolled in this study. Among them, 45 were treated with TACE and sorafenib (T+S group), 61 were treated with TACE alone (T group). In T+S group, sorafenib was orally administered 3-5 days after first TACE (400 mg twice daily). Sorafenib was not interrupted during follow-up TACE treatments. PVTT was classified as follows: tumor involving the main portal vein (type A), right/left portal vein (type B), segmental branches of portal vein (type C) and without portal vein invasion (type D). Baseline characteristics, disease control rate (DCR), time to tumor progression (TTP), overall survival (OS) and adverse events (AEs) were compared for the two groups. Results The baseline characteristics between T+S group and T group were similar (P>0.05). DCR in T+S group was significantly higher than in T group (P=0.001). With the exception of patients with type A, the median TTP and OS of patients with type B, type C and type D were significantly improved in T+S group than in T group (P 0.05); however in patients with type A, liver function at 1 month after treatment deteriorated significantly. 37 patients (82.2%) experienced AEs related to sorafenib. Among them, 9 required sorafenib dose reductions for grade 3 hand-foot skin reactions in 5 patients and grade 3/4 diarrhea in 4 patients; 4 required sorafenib interruption for gastrointestinal hemorrhage. Conclusion TACE combined with sorafenib in patients with advanced HCC was safe. Patients without main portal vein invasion can obtain benefit from the combined treatment, which have a longer TTP and OS than TACE alone. However, in patients with main portal vein invasion, although sorafenib is recommended according to Barcelona Clinic Liver Cancer therapy guide, our results do not support the combination therapy in these patients.