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J Hepatol. 2019 Sep;71(3):516-522. doi: 10.1016/j.jhep.2019.04.021. Epub 2019 May 22.

Pravastatin combination with sorafenib does not improve survival in advanced hepatocellular carcinoma.

Author information

1
Department of Hepato-Gastroenterology, University Hospital F. Mitterrand, Dijon, France. Electronic address: jean-louis.jouve@chu-dijon.fr.
2
Department of Hepato-Gastroenterology, University Hospital Trousseau, Tours, France.
3
Department of Hepato-Gastroenterology, Robert Debré Hospital, Reims, France.
4
Fédération Française de Cancérologie Digestive (FFCD), Dijon, France.
5
Department of Hepato-Gastroenterology, Saint-Jean Hospital, Perpignan, France.
6
Department of Hepato-Gastroenterology, University Hospital Charles Nicolle, Rouen, France.
7
Department of Hepato-Gastroenterology, University Hospital Nord, Amiens, France.
8
Department of Hepato-Gastroenterology, University Hospital Côte de Nacre, Caen, France.
9
Department of Hepato-Gastroenterology, University Hospital Dupuytren, Limoges, France.
10
Department of Hepato-Gastroenterology, Les Oudairies Hospital, La Roche-sur-Yon, France.
11
Department of Medical Oncology, Auxerre Hospital, Auxerre, France.
12
Department of Hepato-Gastroenterology, University Hospital Haut-Lévêque, Pessac, France.
13
Department of Medical Oncology, Centre Catherine de Sienne, Nantes, France.
14
INSERM U954, University of Lorraine and University Hospital of Nancy, Vandoeuvre-les-Nancy, France.
15
Department of Oncology and Hepato-Gastroenterology, University Hospital La Timone, Marseille, France.
16
Department of Hepato-Gastroenterology, La Source Hospital, Orléans, France.
17
Department of Hepato-Gastroenterology, Louise Michel Hospital, Evry, France.
18
Department of Hepato-Gastroenterology, University Hospital F. Mitterrand, Dijon, France; INSERM U1231, University of Bourgogne - Franche-Comté, Faculté de Médecine, Dijon, France.
19
Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne - Hôpital Nord, Saint-Priest-en-Jarez, France.

Abstract

BACKGROUND & AIMS:

Sorafenib is the standard of care for advanced hepatocellular carcinoma (HCC). Combining sorafenib with another treatment, to improve overall survival (OS) within an acceptable safety profile, might be the next step forward in the management of patients with advanced HCC. We aimed to assess whether a combination of sorafenib and a statin improved survival in patients with HCC.

METHODS:

The objective of the PRODIGE-11 trial was to compare the respective clinical outcomes of the sorafenib-pravastatin combination (arm A) versus sorafenib alone (arm B) in patients with advanced HCC. Child-Pugh A patients with advanced HCC who were naive to systemic treatment (n = 323) were randomly assigned to sorafenib-pravastatin combination (n = 162) or sorafenib alone (n = 161). The primary endpoint was OS; secondary endpoints were progression-free survival, time to tumor progression, time to treatment failure, safety, and quality of life.

RESULTS:

After randomization, 312 patients received at least 1 dose of study treatment. After a median follow-up of 35 months, 269 patients died (arm A: 135; arm B: 134) with no difference in median OS between treatments arms (10.7 months vs. 10.5 months; hazard ratio = 1.00; p = 0.975); no difference was observed in secondary survival endpoints either. In the univariate analysis, the significant prognostic factors for OS were CLIP score, performance status, and quality of life scores. The multivariate analysis showed that the only prognostic factor for OS was the CLIP score. The main toxicity was diarrhea (which was severe in 11% of patients in arm A, and 8.9% in arm B), while severe nausea-vomiting was rare, and no toxicity-related deaths were reported.

CONCLUSION:

Adding pravastatin to sorafenib did not improve survival in patients with advanced HCC.

LAY SUMMARY:

Sorafenib has proven efficacy for the treatment of patients with advanced hepatocellular carcinoma. However, overall survival remains poor in these patients, so we were interested to see if the addition of a statin, pravastatin, improved outcomes in patients with advanced HCC. This randomized-controlled trial demonstrated that the sorafenib-pravastatin combination did not improve overall survival in this study population compared to sorafenib alone. Clinical trial number: NCT01075555.

KEYWORDS:

HCC; Liver cancer; RCT; Statins; Systemic therapy; Tyrosine kinase inhibitors

PMID:
31125576
DOI:
10.1016/j.jhep.2019.04.021

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