Abstract
BackgroundTo validate the robust predictive values of tumor vascularity and hand-foot-skin reaction (HFSR) in combination treatment of transarterial chemoembolization (TACE) and sorafenib for patients with intermediate hepatocellular carcinoma (HCC), and then select the potential candidates who would survive best from such treatment.MethodsA total of 132 treatment-naive patients with intermediate HCC undergoing combination therapy of TACE and sorafenib were recruited between January 2010 and December 2014. The tumor vascularity was defined according to digital subtraction angiography (DSA) and HFSR was assessed by the national cancer institute common terminology criteria for adverse events (NCI-CTCAE). The Mann-Whitney U test was used to assess the correlation between vascularity and radiologic response; time to radiologic progression (TTP) and overall survival (OS) were evaluated using Kaplan-Meier techniques and compared by log-rank test; factors associated with them were evaluated using multivariate Cox regression analysis.ResultsDuring a median follow up of 17.3 months, it was revealed that hypervascularity and development of ≥2 grade of HFSR within 60 days after sorafenib initiation were favorable predictors for TTP (HR 0.378, p < 0.001; HR 0.627, p = 0.018) and OS (HR 0.499, p = 0.002; HR 0.555, p = 0.004). The median TTP and OS for patients with both were 12.2 and 29.1 months, which were better than patients with either of them (6.0 months, HR 1.74, p = 0.012; 16.5 months, HR 1.73, p = 0.021), as well as those with neither (2.9 months, HR 3.74, p < 0.001; 11.9 months, HR 3.17, p < 0.001).ConclusionsTumor hypervascularity and development of ≥2 grade of HFSR within 60 days were favorable predictive factors for the combination treatment of TACE and sorafenib, with both of which the patients survived longest and might be the potential candidates.
Highlights
To validate the robust predictive values of tumor vascularity and hand-foot-skin reaction (HFSR) in combination treatment of transarterial chemoembolization (TACE) and sorafenib for patients with intermediate hepatocellular carcinoma (HCC), and select the potential candidates who would survive best from such treatment
The patients were eligible for treatment if they presented with unresectable HCC, an eastern cooperative oncology group (ECOG) performance status of ≤1, adequate hematologic and renal function
Considering that short duration of exposure to sorafenib might impact the judgment of adverse events and the efficacy of combination treatment, 47 patients who were treated with sorafenib for less than 8 weeks were excluded to rule out the potential time-dependent bias [25, 26]
Summary
To validate the robust predictive values of tumor vascularity and hand-foot-skin reaction (HFSR) in combination treatment of transarterial chemoembolization (TACE) and sorafenib for patients with intermediate hepatocellular carcinoma (HCC), and select the potential candidates who would survive best from such treatment. Nearly 20 % of the patients were diagnosed at intermediate stage; and curative treatments, such as resection, liver transplantation or local ablation, might not benefit them [3, 4] For these patients, transarterial chemoembolization (TACE) was most frequently used as a palliative treatment worldwide [5]; besides, according to Barcelona clinic liver cancer (BCLC) staging system and treatment guidelines, TACE as the standard therapy could improve the survival from 16 months in untreated patients to 19.6 months in general patients and to almost 40 months in well-selected ones [6,7,8]. This combination therapy was used in routine clinical practice for the treatment of intermediate HCC, it might not benefit all of these patients [17]
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