The Outcomes and Safety of Single-Agent Sorafenib in the Treatment of Elderly Patients with Advanced Hepatocellular Carcinoma (HCC)

Wong, Hai Ming; Tang, Yuchen; Yao, Tzy‐Jyun; Chiu, Joanne; Leung, Roland; Chan, Pierre; Cheung, Tan To; Chan, Albert C. Y.; Pang, Roberta; Poon, Ronnie Tung‐Ping; Fan, Sheung‐Tat; Yau, Thomas

doi:10.1634/theoncologist.2011-0192

Cited by 60 publications

(69 citation statements)

References 48 publications

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“…It included 172 consecutive patients with advanced HCC and compensated cirrhosis treated with sorafenib and reported that OS (5.32 vs 5.16 months) and AEs related to sorafenib were comparable in a cohort of 35 elderly patients (≥70 years) and one of 135 younger patients (<70 years). Unsurprisingly, the older patients more frequently experienced comorbid cardiovascular conditions, but were also found to suffer grade 3 or 4 malaise, mucositis and neutropenia significantly more frequently than the younger cohort [58].…”

Section: Using Sorafenib In Child-pugh B Patientsmentioning

confidence: 89%

Refining Sorafenib Therapy: Lessons from Clinical Practice

et al. 2014

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AbstrAct:Understanding the best use of sorafenib is essential in order to maximize clinical benefit in hepatocellular carcinoma. Based on Phase III and noninterventional study data, as well as our extensive experience, we discuss dose modification in order to manage adverse events, disease response evaluation and how to maximize treatment benefit. Sorafenib should be initiated at the approved dose (400 mg twice daily) and reduced/ interrupted as appropriate in order to manage adverse events. Dose modification should be considered before discontinuation. Appropriate tumor response assessment is critical. Focusing on radiologic response may result in premature sorafenib discontinuation; symptomatic progression should also be considered. If second-line therapies or trials are unavailable, continuing sorafenib beyond radiologic progression may provide a clinical benefit. Our recommendations enable the maximization of treatment duration, and hence clinical benefit, for patients. Keywords:• adverse event managementIt is well established that hepatocellular carcinoma (HCC) is a complex and heterogeneous disease that is affected by multiple genetic and epigenetic alterations [1]. In the overwhelming majority of patients, liver cirrhosis -another complex disease in its own right -is superimposed on HCC. As a result, the prognostic range for these patients varies considerably and continues to change for each patient at every time point over the clinical course of their disease. A meta-analysis of 30 clinical trials into which HCC patients were enrolled for palliative treatment reflects this heterogeneity. It demonstrated a high variability in survival among untreated patients and concluded that no single patient characteristic alone could predict outcome [2].The prognosis and treatment options for HCC are generally related to tumor stage and liver function at presentation [3,4]. In the west, approximately 30% of all patients with HCC are diagnosed in

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Section: Using Sorafenib In Child-pugh B Patientsmentioning

confidence: 89%

Refining Sorafenib Therapy: Lessons from Clinical Practice

et al. 2014

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“…In a population of advanced renal cell carcinoma patients aged ≥70 years, sorafenib was shown to be as safe and effective as in patients aged <70 years [23]. More recently, older populations with advanced HCC treated with sorafenib were compared with younger groups [24,25]. A comparison between a group of 35 elderly (age ≥70 years) patients and 137 younger (≤70 years) patients was reported [25].…”

Section: Discussionmentioning

confidence: 99%

Sorafenib in Elderly Patients with Advanced Hepatocellular Carcinoma: A Case Series

Montella¹,

Addeo²,

Cennamo³

et al. 2013

Oncology

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Objective: The management of hepatocellular carcinoma (HCC) in elderly patients is significantly more complicated than in younger patients because of medical comorbidities, advanced status at diagnosis, reduced liver function and altered drug pharmacokinetics. Our objective was a revision of the charts of unselected elderly patients with HCC being treated with a reduced starting dose of sorafenib. Methods: Activity, adverse events and quality of life were evaluated during the treatment. Sixty patients (47 males and 13 females) aged more than 70 years old (range 70-90, median 76 years) were retrospectively reviewed. Results: One complete and one partial response were achieved in the series (overall response rate 3.3%). Stable disease accounted for 76.6% (46 out of 60 patients). The disease control rate (complete plus partial response plus stable disease) was 80%. Median time to progression (TTP) was 7.0 months (95% CI, 5.2-8.7 months) and median survival was 10.0 months (95% CI, 5.0-14.9 months). Thrombosis correlated to TTP. Full doses of sora-fenib were reached in 11 out of 60 patients (18.3%). The evaluation of quality of life did not show any significant change during the study. Conclusions: Sorafenib at a reduced dose can be safely used in elderly HCC patients with maintenance of activity and increased tolerability.

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“…The efficacy of sorafenib in elderly patients is supported by a number of studies [69][70][71][72] , which showed similar, or even a trend to longer, overall survival and time to progression in elderly patients compared with younger subjects. Overall, evidence collected to date shows that the efficacy and safety profile of sorafenib is not influenced by age [73,74] .…”

Section: Sorafenibmentioning

confidence: 95%

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under-or no-treatment of aged patients should not be longer justified. Core tip: The number of elderly patients with cancer is expected to rise in the next future, and facing with elderly cirrhotic patients with hepatocellular carcinoma (HCC) will characterize liver oncology scenario in the near future. International guidelines do not specifically address how to approach HCC in aged patients and no recommendations are available on age threshold to which clinical decisions should refer. Available data seem to rule out an intrinsic negative impact of age itself on HCC prognosis, and treatment allocation should be decided mainly according to HCC stage, liver residual function and general conditions. Indeed, a nihilistic AbstractMean age of hepatocellular carcinoma (HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific REVIEWSubmit a

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The Outcomes and Safety of Single-Agent Sorafenib in the Treatment of Elderly Patients with Advanced Hepatocellular Carcinoma (HCC)

Cited by 60 publications

References 48 publications

Refining Sorafenib Therapy: Lessons from Clinical Practice

Refining Sorafenib Therapy: Lessons from Clinical Practice

Sorafenib in Elderly Patients with Advanced Hepatocellular Carcinoma: A Case Series

Management of hepatocellular carcinoma in the elderly

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