The prognostic factors between different viral etiologies among advanced hepatocellular carcinoma patients receiving sorafenib treatment

Abstract

Sorafenib is currently the first‐line therapy for advanced hepatocellular carcinoma (aHCC) patients. However, the outcomes and prognostic factors of sorafenib therapy have not been well investigated. We aimed to investigate the pretreatment factors and outcomes among Taiwanese aHCC patients receiving sorafenib treatment. A total of 347 patients with aHCC and well‐compensated liver cirrhosis (Child‐Pugh A) status receiving sorafenib were consecutively enrolled from March 2013 through December 2016. Pre‐treatment clinical data and viral hepatitis markers were collected and analyzed with their outcomes. The primary endpoint of the study was overall survival. The factors associated with overall survival were also investigated. The median overall survival of all the patients was 238 days (range, 9‐1504 days) with a 1‐year overall survival of 43.2%. Positive hepatitis B surface antigen and absence of portal vein thrombosis (PVT) were independent factors associated with better overall survival. The median duration of sorafenib therapy was 93.0 days (range, 4‐1504 days). After stopping sorafenib, the median survival was 93.0 days (range, 1‐1254 days). The 1‐year survival after stopping sorafenib was 21.2%. In chronic hepatitis B patients, total bilirubin level was the only factor associated with overall survival. Hepatitis C antibody RNA negativity, tumor size, PVT, and white blood cell count were the independent factors associated with survival among those chronic hepatitis C patients. There were different prognostic factors stratified by viral etiologies in aHCC patients receiving sorafenib. Viral eradication increased survival in chronic hepatitis C patients.

Regorafenib for Taiwanese patients with unresectable hepatocellular carcinoma after sorafenib failure: Impact of alpha‐fetoprotein levels

“… 16 , 17 The median OS after sorafenib discontinuation in the current study was 15.2 months, which was remarkably longer than that in patients who received sorafenib alone (3.8 months, p < 0.001). 14 Similar results were observed even after matching age, sex, Child–Pugh status, BCLC stage, and AFP level at the time of sorafenib discontinuation (15.3 vs. 5.2 months, p < 0.001), which indicated the survival benefit of regorafenib on uHCC after progression with sorafenib.…”

“…The median OS following sorafenib discontinuation was 15.2 months (95% CI, 13.3–17.2) in patients treated with regorafenib in the present study, which was remarkably longer than that in our previous cohort, which contained patients who received sorafenib alone (3.8 months; 95% CI, 2.8–4.7; p < 0.001) (Figure S2A ). 14 After propensity score matching, patients from the present study (sorafenib–regorafenib, n = 81) still showed a better median OS after sorafenib discontinuation (15.3 months; 95% CI, 12.5–18.1) than those in the historical control group ( n = 81; 5.2 months; 95% CI, 2.5–7.9; p < 0.001) (Table S1 , Figure S2B ).…”

“…Tolerability was assessed during every visit to the clinic and was graded based on the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. To address the survival benefit of regorafenib, another consecutive group consisting of age‐, sex‐, Child–Pugh status‐, BCLC stage‐, and AFP level (≥400 or <400 ng/ml)‐matched patients who received sorafenib alone 14 was selected as a historical control with a 1:1 propensity score matching ratio. We compared the OS after sorafenib discontinuation between patients in the current study and those in the historical control group.…”

Potential Impact of IMbrave150 Results in the Evolving Treatment Landscape of Advanced Hepatocellular Carcinoma: A Multidisciplinary Expert Opinion

“…13 Available data regarding response to therapy based on HCC etiology suggest that sorafenib provides a greater benefit in patients infected with hepatitis C virus (HCV); this benefit was less pronounced in patients infected with hepatitis B virus (HBV). 14,15 It is not known if the consistently improved OS associated with sorafenib in patients with HCV is related to active viral replication or if this effect persists after a sustained viral response is achieved. Of note, lenvatinib was associated with the submit your manuscript | www.dovepress.com…”

Eradication of hepatitis C virus preserve liver function and prolong survival in advanced hepatocellular carcinoma patients with limited life expectancy

“…A lack of responsive to systemic treatment limits the survival of patients with advanced stage HCC (aHCC) 6 . Administration of sorafenib prolongs overall survival in aHCC patients to more than 10 months 7–9 and has been recommended as the first‐line standard of care for 10 years 10–12 . Several kinase inhibitors, including lenvatinib regorafenib, carbozantinib, and ramucirumab, showed non‐inferior efficacy to sorafenib and prolonged survival after sorafenib failure, providing additional treatment options for patients with aHCC 13–16 …”