Patterns and challenges of treatment sequencing in patients with hepatocellular carcinoma: Experience from a German referral center

Kirstein, Martha M.; Schweitzer, Nóra; Winter, Theresa; Lappas, K.; Graen, N.; Kunstmann, I.; Voigtländer, Torsten; Reineke‐Plaaß, Tanja; Manns, Michael P.; Lehner, Frank; Rodt, Thomas; Vogel, Arndt

doi:10.1111/jgh.13761

Cited by 18 publications

(21 citation statements)

References 31 publications

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“…Many patients who receive repeated loco-regional treatments regardless of tumor stage experience a progressive impairment of liver function, rendering the initiation of effective systemic therapies impossible [2,3]. In line with this, several single center retrospective studies have shown that in clinical routine less than 20% of patients have received systemic treatment in the past [4]. Similar observations were reported from the large BRIDGE study, a multiregional, longitudinal cohort study to document real-life management of patients with HCC to provide a better understanding of global treatment patterns in HCC.…”

Section: Transition From Local Therapies To Systemic Therapiesmentioning

confidence: 99%

Current strategies for the treatment of intermediate and advanced hepatocellular carcinoma

Vogel

Saborowski

2020

Cancer Treatment Reviews

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109

128

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Section: Transition From Local Therapies To Systemic Therapiesmentioning

confidence: 99%

Current strategies for the treatment of intermediate and advanced hepatocellular carcinoma

Vogel

Saborowski

2020

Cancer Treatment Reviews

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109

128

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“…Similarly, a decrease in hepatic function as assessed by CPS and ALBI score was evident in our study. These data strongly suggest that liver synthesis parameters need to be carefully monitored during systemic treatment as liver function can deteriorate as it has been observed after locoregional treatments such as TACE 23 . The deterioration of hepatic function is specifically crucial in patients with a restricted hepatic function due to an underlying liver cirrhosis.…”

Section: Discussionmentioning

confidence: 91%

Sequential systemic treatment in patients with hepatocellular carcinoma

Kirstein

Scheiner

Marwede

et al. 2020

Aliment Pharmacol Ther

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Summary Background Hepatocellular carcinoma (HCC) is one of the most lethal cancers. After many years of stagnation, there are now several systemic treatments available for patients with HCC. Aim To analyse the feasibility and efficacy of sequential systemic treatments in patients with HCC in clinical practice. Methods In this multicentre study, patients who were treated with novel systemic therapies for HCC between 2014 and 2019 at two referral centres, Hannover Medical School, Germany, and Medical University of Vienna, Austria, were included. Results Overall, 85 patients were included of which 76 patients (89.4%) received more than one and a maximum of five systemic treatment lines. The most common therapy sequence was sorafenib (n = 72; 84.7%) followed by regorafenib (n = 37; 48.7%), whereas 11 patients were initially treated with lenvatinib (12.9%). Other second‐line treatments included pembrolizumab, nivolumab, cabozantinib and ramucirumab. Hepatic function deteriorated during sequential systemic treatment in 48.6% of the patients as defined by an increase in at least one Child‐Pugh point. Median overall survival (mOS) from the start of first systemic treatment was 35 months for patients with sequential systemic treatment compared to 9 months for patients with one systemic treatment line (P < 0.001). Patients previously treated with surgical/locoregional therapies had a longer mOS compared to patients with initial systemic treatment (66 vs 25 months; P = 0.020). Conclusions Sequential systemic treatment is feasible and effective in selected patients with HCC in clinical practice. Our study underlines the critical importance of well‐preserved liver function for successful administration of sequential systemic therapy.

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“…The TACE treatment rationale is that the intraarterial infusion of cytotoxic agents followed by tumor‐feeding blood vessel embolization induces strong cytotoxic and ischemic effects in tumors. Database analyses in other countries also reported that TACE was the most frequently selected first‐line treatment …”

Section: Discussionmentioning

confidence: 99%

Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages

Akada

Koyama

Taniguchi

et al. 2019

Pharmacology Res & Perspec

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Despite recent developments in treatment modalities and diagnosis, the prognosis of advanced hepatocellular carcinoma ( HCC ) remains unsatisfactory. To gain insight into treatment decisions for HCC patients, their characteristics and treatment flow in the early and advanced stages were examined. HCC patients' characteristics and treatment flow were retrospectively analyzed using the Japanese medical claims database. The 8999 patients' mean age at HCC diagnosis was 71.1 years, with no difference between early (Stage I/ II ) and advanced (Stage III / IV ) stages. The mean observation period was 26.2 months, shorter in advanced than in early stages. HCV hepatitis was reported in 52.0% of HCC patients, with concomitant hypertension in 53.4%, type 2 diabetes in 45.8%, cirrhosis in 39.3%, and hyperlipidemia in 15.5%. The rates of HCV hepatitis, hypertension, and hyperlipidemia decreased with stage progression. Analysis of treatment flow showed that, at all disease stages, transcatheter arterial chemoembolization ( TACE ) was the most common first to fourth‐line treatment. Epirubicin was the most frequently (44.1%) used chemotherapeutic agent for first‐line TACE , followed by miriplatin (23.6%) and cisplatin (12.3%). With stage progression, cisplatin use increased. Sorafenib was used concomitantly for first‐line TACE in 3.2% of patients, and its use increased significantly in advanced stages. Clear differences in baseline characteristics and treatment flow between early and advanced stages were identified. Continuous analysis of the database with longer follow‐up may provide useful information about treatment selection and prediction of outcome such as survival.

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Patterns and challenges of treatment sequencing in patients with hepatocellular carcinoma: Experience from a German referral center

Cited by 18 publications

References 31 publications

Current strategies for the treatment of intermediate and advanced hepatocellular carcinoma

Current strategies for the treatment of intermediate and advanced hepatocellular carcinoma

Sequential systemic treatment in patients with hepatocellular carcinoma

Database analysis of patients with hepatocellular carcinoma and treatment flow in early and advanced stages

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