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Cancer Chemother Pharmacol. 2018 Sep;82(3):469-478. doi: 10.1007/s00280-018-3638-0. Epub 2018 Jul 7.

Randomized, prospective, comparative study on the effects and safety of sorafenib vs. hepatic arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein tumor thrombosis.

Author information

1
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
2
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. wjchung50@gmail.com.
3
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. baesh@catholic.ac.kr.
4
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
5
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
6
Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
7
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
8
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.

Abstract

BACKGROUND/AIMS:

Treatment responses of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remain unacceptably low and treatment modalities are limited. We compared the efficacy and safety of sorafenib and hepatic arterial infusion chemotherapy (HAIC).

METHODS:

In this randomized, prospective, comparative study, data on 58 patients with advanced HCC with PVTT, with Child-Turcotte-Pugh (CTP) scores of 5-7, were collected from six university hospitals between January 2013 and October 2015. Twenty-nine patients were treated with sorafenib and twenty-nine with HAIC.

RESULTS:

The median overall survival (OS) and time to progression (TTP) were significantly longer in the HAIC group than in the sorafenib group (14.9 vs.7.2 months, p = 0.012 and 4.4 vs. 2.7 months, p = 0.010). The objective response (OR) rates were 27.6 and 3.4% in the HAIC and sorafenib groups, respectively (p = 0.001). In univariate analysis, sex, main portal vein invasion and treatment modality were significant prognostic factors of OS (p = 0.044, 0.040, 0.015), whereas cause of HCC, tumor number, tumor location and treatment modality were significant prognostic factors of TTP (p = 0.040, 0.002, 0.034, 0.014). In multivariate analysis, sex and treatment modality were significant prognostic factors of OS (p = 0.008, 0.005), whereas cause of HCC, tumor number, tumor location and treatment modality were significant prognostic factors of TTP (p = 0.038, 0.038, 0.015, 0.011). Major complications included hyperbilirubinemia (44.8%), AST elevation (34.5%), ascites (13.8%) and catheter-related complications (3.4%) in the HAIC group and hyperbilirubinemia (34.5%), hand-foot syndrome (31.0%) and AST elevation (27.6%) in the sorafenib group.

CONCLUSIONS:

For managing advanced HCC with PVTT, HAIC may be a valuable treatment modality.

KEYWORDS:

Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Portal vein tumor thrombosis; Prognosis; Sorafenib

PMID:
29982870
DOI:
10.1007/s00280-018-3638-0

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