Adoption of Sorafenib for the Treatment of Advanced-Stage Hepatocellular Carcinoma in Oncology Practices in the United States

Abstract

Background: The adoption of sorafenib into oncology practice as a first-line systemic treatment for advanced hepatocellular carcinoma (HCC) is not well understood. We examined sorafenib use since Food and Drug Administration (FDA) approval in 2007 and associated survival for individuals diagnosed with advanced HCC, conducting a population-based evaluation of treatment patterns and outcomes for this newly approved drug in the US over time. Methods: We identified individuals diagnosed with Barcelona Clinic Liver Cancer Stage C from the 2007 and 2012 National Cancer Institute Patterns of Care study. We examined trends in use as well as patient and clinical factors associated with receiving sorafenib using multivariate logistic regression analysis. We then evaluated the association between sorafenib use and overall hazard of death using multivariate Cox proportional hazards regression. Results: Among 550 individuals diagnosed with advanced HCC, we found no significant increase in the proportion of patients treated with sorafenib from 2007 to 2012 (26.3 vs. 30.4%). After adjusting for patient and clinical characteristics, non-Hispanic Blacks (compared to non-Hispanic Whites) and those with a lower Child-Pugh score remained more likely to receive sorafenib. Individuals receiving systemic chemotherapy only, radiation therapy only, or no treatment at all experienced a higher risk of death than those treated with sorafenib, while those receiving a transplant experienced a lower risk of death. Conclusions: Sorafenib has not been widely adopted into oncology practice since FDA approval for advanced HCC. Few factors apart from Child-Pugh score and race/ethnicity predict sorafenib use in clinical practice, although sorafenib treatment is associated with a lower risk of death.

GHR knockdown enhances the sensitivity of HCC cells to sorafenib

“…Sorafenib, a small molecule, is well known for inhibiting tumor angiogenesis and promoting tumor cell apoptosis [ 6 ]. It is approved for treatment of advanced HCC by the Drug Administration in 2007 [ 7 ]. However, most advanced HCCs obtain resistance to sorafenib, eventually leading to tumor growth or distant metastasis overtime [ 8 ].…”

“…Sorafenib, an oral multi-kinase inhibitor, inhibits tumor angiogenesis and reduces tumor cell apoptosis [ 6 ]. In 2007, it is approved for the treatment of advanced HCC by the Drug Administration [ 7 ]. The mechanism underlying the therapeutic effects of sorafenib on HCC has been well studied.…”

The Synergistic Cytotoxic Effect of Laser-Irradiated Gold Nanoparticles and Sorafenib Against the Growth of a Human Hepatocellular Carcinoma Cell Line

“…Sorafenib, an oral multikinase inhibitor drug with anti-proliferative and anti-angiogenic effects, has been approved by the US Food and Drug Administration (FDA) as a unique target drug for advanced HCC (Parsons et al, 2017). Although it represents a much-required treatment decision for HCC patients, it produces toxicities that affect patients' quality of life (Morisaki et al, 2013).…”

Randomised, multicentre prospective trial of transarterial chemoembolisation (TACE) plus sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial

“…Sorafenib has since been approved worldwide and has become the standard treatment for patients with advanced unresectable HCC. Because TACE and sorafenib have each been shown to prolong survival in patients with unresectable HCC,13–17 their combination may improve clinical outcomes 18–21. To date, however, all five randomised controlled trials testing combinations of TACE with molecular targeted agents such as sorafenib, brivanib and orantinib have failed to show clinical benefits of these combinations 22–27…”