Comparison of hepatic arterial infusion chemotherapy and sorafenib in elderly patients with advanced hepatocellular carcinoma: A case series

Abstract

Sorafenib and hepatic arterial infusion chemotherapy (HAIC) are both indicated for unresectable hepatocellular carcinoma (HCC). In this study, we compared the efficacy and safety of HAIC to that of sorafenib in elderly patients with HCC. Eligible patients included those aged ≥70 years, with histologically or clinically confirmed advanced HCC. A total of 12 patients received sorafenib (800 mg per day) and 8 patients received HAIC with 5-fluorouracil (300 mg/m on days 1-5 and 8-12) with or without cisplatin (20 mg/m on days 1 and 8), with interferon-α (3 times per week for 4 weeks). The response rate was significantly higher in patients treated with HAIC (37.5%) compared to that in patients treated with sorafenib (no response). The median overall survival (18.6 and 11.7 months) and progression-free survival (4.0 and 5.0 months) were similar between the sorafenib and HAIC groups, respectively. In the sorafenib group, 58.3% of the patients discontinued treatment compared to none in the HAIC group. The most frequent adverse event leading to discontinuation of sorafenib was anorexia. Similar to sorafenib, HAIC appears to be a feasible treatment and may also have the advantage of an adequate safety profile for elderly patients with advanced HCC. Further study of HAIC in a larger population of elderly patients is required to assess its potential as an alternative to sorafenib for HCC.

A meta-analysis comparing hepatic arterial infusion chemotherapy and sorafenib for advanced hepatocellular carcinoma

“…Thirteen studies ( 17 , 18 , 20 , 22 - 25 , 27 , 29 , 31 - 34 ) were pooled for the outcome of PFS. Our meta-analysis showed a significant benefit in PFS in favor of HAIC compared with sorafenib (HR: 0.55, 95% CI: 0.44–0.69; P<0.001) ( Figure 3 ).…”

“…Data from 2 studies overlapped, and conference abstracts without full-text articles were also excluded. Finally, nineteen studies, including 17 retrospective studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), 1 prospective cohort study (33) and 1 prospective randomized controlled study (34), were included.…”

“…The publication period ranged from 2011 to 2020. Among the studies, twelve were conducted in Japan (16,(18)(19)(20)(21)(22)(23)(24)(25)28,30,33), six were conducted in Korea (17,26,27,31,32,34), and one was conducted in China (29). Cisplatin and 5-fluorouracil (5-FU) were the most frequently used regimens in HAIC.…”

“…Eighteen studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(26)(27)(28)(29)(30)(31)(32)(33)(34) reported OS outcomes. Our meta-analysis demonstrated that HAIC was superior to sorafenib in the treatment of advanced HCC with respect to OS (HR: 0.66, 95% CI: 0.46-0.95; P=0.027) (Figure 2).…”

“…Eighteen studies (16)(17)(18)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) reported the ORR. Among those studies, ten (16,18,(21)(22)(23)(24)(25)28,29,33) reported an ORR that was evaluated by the RECIST criteria. The heterogeneity was not significant in those studies (I 2 =25.4%, P=0.210).…”