Sorafenib treatment for advanced hepatocellular carcinoma: Effectiveness, safety, and controversial points.

Abstract

496 Background: Sorafenib is only molecular target drug for hepatocellular carcinoma (HCC) in worldwide, however the effect and toxicity are different from cytotoxic anticancer agent. We evaluated that the efficacy and safety of sorafenib for unresectable HCC. Methods: This study population included fifty-eight patients that we can follow-up in 80 patients treated by sorafenib between May 2009 and May 2015 in our hospital. We evaluated the profile of sorafenib treatment (cause, initial dose, rate of changing dose), clinical response by mRECIST, adverse events by CTCAE v.4.0, Overall survival (OS) (total OS, median OS), conversion therapy and tumor response after progressive disease (PD). Results: HBV/HCV/alcohol/NBNC: 17/19/15/5, Child Pugh grade A/B: 54/4, cStage Ⅱ/Ⅲ/ⅣA/ⅣB: 1/17/15/23, extrahepatic spread(EHS) (lung /bone /adrenal gland /others): 9/5/2/7, prior treatment : 42/58 (72.4%). Cause of sorafenib treatment : TACE refractory (28%), vascular invasion or EHS (48%), initial dose 400mg (90%), changing dose :escalation (400→800); 15.5% reduction;10.3%. tumor response: objective response; 11.4%, disease control rate (DCR); 60.5%, OS: median OS 8.6 months, 3 year survival rate; 8.1%. There was significant difference in OS between Child Pugh score(CPS) (CPS:5, mOS 17.8 months, p < 0.01). Adverse events: skin disorders (17.2%), gastrointestinal disorders (17.2%), hepatobilliary disorders (17.2%), respectively. In clinical course of after PD response, 10 patients (17.2%) received hepatic arterial infusion chemotherapy for conversion therapy from sorafenib, and had 40% of DCR. Conclusions: Sorafenib is good therapeutic drug for advanced HCC and TACE refractory patients. Taking 400mg dosage of sorafenib is good response which depends on liver function. After PD response by sofafenib, conversion therapy from sorafenib has possibilities of good response.