Abstract
BackgroundSorafenib and transarterial chemoembolization (TACE) are recommended therapies for advanced hepatocellular carcinoma (HCC), but their combined efficacy remains unclear.MethodsBetween 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.ResultsThe 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.ConclusionsCompared with sorafenib alone, combining TACE with sorafenib might prolong survival and delay disease progression in patients with advanced HCC.
Highlights
Sorafenib and transarterial chemoembolization (TACE) are recommended therapies for advanced hepatocellular carcinoma (HCC), but their combined efficacy remains unclear
Patients treated with TACE and sorafenib were included in the TACE + sorafenib group (n = 56); patients who were treated only with sorafenib were included in the sorafenib group (n = 48)
The baseline demographic and clinical characteristics were similar between the two treatment groups, except that patients in the TACE + sorafenib group had a significantly higher level of ALB (P = 0.028) and proportionally more patients with Child-Pugh class A disease (P = 0.017)
Summary
Sorafenib and transarterial chemoembolization (TACE) are recommended therapies for advanced hepatocellular carcinoma (HCC), but their combined efficacy remains unclear. Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world [1], and a variety of treatments are available [2,3,4]. According to the Barcelona Clinic Liver Cancer (BCLC) Group, patients with BCLC stage B/C HCC are not suitable for surgery [5]. Suitable alternative treatments for patients with BCLC stage B and C HCC are transarterial chemoembolization (TACE) and sorafenib, respectively. TACE is widely used as a palliative treatment for patients with advanced HCC and has been reported to prolong survival [8, 9]. Some studies [13, 14] have observed that the vascular endothelial growth factor (VEGF) level increases after TACE, suggesting that a pharmacologic intervention that impairs VEGF signaling and the development of new blood vessels could be a clinically useful adjuvant therapy for TACE
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