Transarterial chemoembolization (TACE) and sorafenib are the therapeutic standard for intermediate and advanced stage hepatocellular carcinoma (HCC) patients respectively. High costs with adverse events (AE) of sorafenib might limit sorafenib dosage, further affecting therapeutic response. To attain greatest benefit, we evaluated the efficacy of different doses and effect of TACE during and after sorafenib discontinuation in patients representing Child-Pugh Classification Class A with venous or extra-hepatic invasion.
A total 156 patients met the criteria and were divided into Groups I (n = 52) accepting 800 mg/day; II (n = 58) accepting 800 mg/day and reduced to 400 mg/day owing to AE; and III (n = 46) accepting 400 mg/day. TACE was performed during and after sorafenib discontinuation and therapeutic response bimonthly to four-monthly was rated thereafter.
Median duration of sorafenib treatment and patients’ survival were 4.00 ± 0.45 and 7.50 ± 1.44 months in all cases; 2.50 ± 0.90 and 5.00 ± 1.10 months in Group I; 5.50 ± 1.27 and 16.50 ± 1.86 months in Group II; 4.00 ± 0.94 and 6.50 ± 2.49 months in Group III. Group II presented the best response and survival benefit (p = 0.010 and p = 0.011 respectively). Child-Pugh Classification score 5 (Hazard Ratio = 0.492, p = 0.049), absent AE (3.423, p = 0.015), tumor numbers ≤ 3 (0.313, p = 0.009), sorafenib duration ≤ 1 cycle (3.694, p = 0.004), and absent TACE (3.197, p = 0.008) significantly correlated with patient survival. TACE benefit appeared in separate and total cases during (p = 0.002, p = 0.595, p = 0.074, p = 0.002 respectively) and after discontinuation of sorafenib administration (p = 0.001, p = 0.034, p = 0.647, p = 0.001 respectively).
Low-dosage sorafenib not only appeared tolerable and lowered economic pressure but also provided satisfactory results. TACE benefited patient’s survival during and after sorafenib discontinuation.
Dose-efficacy Sorafenib TACE Hepatocellular carcinoma patient
Citation: Wang-De Hsiao, Cheng-Yuan Peng, Po-Heng Chuang, Hsueh-Chou Lai et al.Evaluation of dose-efficacy of sorafenib and effect of transarterial chemoembolization in hepatocellular carcinoma patients: a retrospective study BMC series – open, inclusive and trusted 2016 16:50 DOI: 10.1186/s12876-016-0464-x
Received: 27 October 2015 Accepted: 15 April 2016 Published: 27 April 2016
Copyright: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
All procedures met ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1975 Helsinki Declaration, as revised in 2008. The Institutional Review Board of China Medical University Hospital also approved this retrospective study (CMUH103-REC2-147). Importantly, heartfelt thanks to participants, as well as research assistants of the Liver Unit for technical assistance in data collection and case enrollment.
The authors declare that they have no competing interests.
J-TK and W-DH involved in the study design, as well as in the planning, conducting, collecting and interpreting of data for this study, and in drafting/editing the manuscript. C-YP involved in the planning, collection and interpretation of data for this study, and in drafting the manuscript. P-HC and H-CL involved in data collection and drafting/editing of the manuscript. K-SC, J-WC, Y-YC, C-J, C-LF, W-PS, and S-HC involved in data collection. All the above-mentioned authors have approved the final draft submitted.