Treatment of Advanced Hepatocellular Carcinoma after Failure of Sorafenib Treatment: Subsequent or Additional Treatment Interventions Contribute to Prolonged Survival Postprogression

Abstract

Background Sorafenib is a first-line treatment option for advanced hepatocellular carcinoma (HCC) patients; however, survival predictors upon progression have not been well characterized. In the present study, we aimed to show the efficacy of multidisciplinary therapy for patients who had failed to respond to sorafenib treatment. Methods Among 146 BCLC stage B or C HCC patients treated with sorafenib monotherapy between July 2009 and August 2014, the first radiological progression according to the modified RECIST was identified in 71 patients; factors predicting overall survival (OS) and survival postprogression (SPP) were analyzed in these patients. Results The median OS and SPP for patients who failed to respond to sorafenib treatment were 10.5 and 6.2 months, respectively, and the SPP was strongly correlated with the OS (r = 0.982, P < 0.01, and R2 = 0.965). The independent predictors of OS and SPP were identical. The predictors of SPP were des-gamma-carboxy prothrombin, progression of portal vein thrombosis, and subsequent second-line or additional treatment. Conclusions SPP is closely associated with OS and might be notable in patients who have failed to respond to initial sorafenib treatment. Furthermore, interventions consisting of other treatment options upon the appearance of progression might prolong OS.

Skeletal muscle mass is associated with toxicity, treatment tolerability, and additional or subsequent therapies in patients with hepatocellular carcinoma receiving sorafenib treatment

“…Furthermore, after failure of sorafenib treatment, additional or subsequent treatment including TACE has been reported to contribute to prolonged survival postprogression and might prolong OS. 45 As these findings indicated that additional or subsequent treatment seems to be associated with OS, patients with LSMM who were less likely to receive additional or subsequent therapies had poor OS in the present study.…”

Skeletal Muscle Volume Is an Independent Predictor of Survival after Sorafenib Treatment Failure for Hepatocellular Carcinoma

“…In this study, TACE and HAIC were used as salvage options for post-sorafenib therapy. It has been previously reported that subsequent therapy, including TACE and HAIC, contributes to prolonging PPS after sorafenib therapy [ 30 , 31 , 32 ]. We also demonstrate that post-sorafenib therapy is an independent prognostic factor for OS, similar to the PPS prognostic factor ( Table S5 and Figure S4 ).…”

Therapeutic effects of regorafenib after sorafenib monotherapy with advanced hepatocellular carcinoma including Child–Pugh classification B

“…Previous studies have reported that survival time after sorafenib initiation is correlated with the survival time after failed sorafenib treatment in advanced HCC. [ 19 , 20 ] This suggested the importance of second-line treatment choices after sorafenib, indicating the validity of regorafenib as a treatment of choice.…”