Treatment of Advanced Hepatocellular Carcinoma after Failure of Sorafenib Treatment: Subsequent or Additional Treatment Interventions Contribute to Prolonged Survival Postprogression.

Masaaki Kondo,Koji Hara,Hiroyuki Fukuda,Makoto Chuma,Kazushi Numata,Shin Maeda,Akito Nozaki,Katsuaki Tanaka

doi:10.1155/2017/5728946

Abstract

Background Sorafenib is a first-line treatment option for advanced hepatocellular carcinoma (HCC) patients; however, survival predictors upon progression have not been well characterized. In the present study, we aimed to show the efficacy of multidisciplinary therapy for patients who had failed to respond to sorafenib treatment. Methods Among 146 BCLC stage B or C HCC patients treated with sorafenib monotherapy between July 2009 and August 2014, the first radiological progression according to the modified RECIST was identified in 71 patients; factors predicting overall survival (OS) and survival postprogression (SPP) were analyzed in these patients. Results The median OS and SPP for patients who failed to respond to sorafenib treatment were 10.5 and 6.2 months, respectively, and the SPP was strongly correlated with the OS (r = 0.982, P < 0.01, and R2 = 0.965). The independent predictors of OS and SPP were identical. The predictors of SPP were des-gamma-carboxy prothrombin, progression of portal vein thrombosis, and subsequent second-line or additional treatment. Conclusions SPP is closely associated with OS and might be notable in patients who have failed to respond to initial sorafenib treatment. Furthermore, interventions consisting of other treatment options upon the appearance of progression might prolong OS.

Highlights

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality globally [1]
We investigated whether the interventions of subsequent second-line or additional treatment options could contribute to survival postprogression (SPP) for patients who failed to respond to initial sorafenib treatment
To obtain long-term survival after sorafenib treatment, various treatment modalities other than sorafenib are often administered in the form of multidisciplinary therapy [11]; the efficacy of multidisciplinary treatment in patients who have failed to respond to sorafenib has not yet been established

Summary

Introduction

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality globally [1]. Sorafenib has been reported to improve the overall survival (OS) of advanced HCC patients, compared with those receiving a placebo [5, 6] and is currently the only first-line treatment available for BCLC stage C patients. About half of these patients achieve disease control, a critical issue in clinical practice is the absence of a second-line treatment for those who fail to respond to sorafenib treatment. Sorafenib is a first-line treatment option for advanced hepatocellular carcinoma (HCC) patients; survival predictors upon progression have not been well characterized. Among 146 BCLC stage B or C HCC patients treated with sorafenib monotherapy between July 2009 and August 2014, the first radiological progression according to the modified RECIST was identified in 71 patients; factors predicting overall survival (OS) and survival postprogression (SPP) were analyzed in these patients. Interventions consisting of other treatment options upon the appearance of progression might prolong OS

Objectives

Methods

Results

Conclusion