Sorafenib after Arterial Chemoembolization in Child-Pugh A and B Cirrhotic Patients with Intermediate Hepatocellular Carcinoma: A Retrospective Analysis

Fernando Gomes Romeiro^1*, Luciana Yumi Odani Sigahi², Matheus Alvarez³, Fabio da Silva Yamashiro¹, Fábio Cardoso de Carvalho¹, Leonardo Pelafsky⁴, Talles Bazeia Lima¹, Letícia de Campos Franzoni¹, José Ricardo de Arruda Miranda³, Giovanni Faria Silva¹

¹Gastroenterology Division, Department of Internal Medicine, Faculdade de Medicina de Botucatu, UNESP—Univ Estadual Paulista, Sao Paulo, Brazil.
²Faculdade de Medicina de Botucatu, UNESP—Univ Estadual Paulista, Sao Paulo, Brazil.
³Department of Physics and Biophysics, Instituto de Biociências de Botucatu, UNESP—Univ Estadual Paulista, Sao Paulo, Brazil.
⁴Gastroenterology Division, Department of Surgery and Orthopedics, Faculdade de Medicina de Botucatu, UNESP—Univ Estadual Paulista, Sao Paulo, Brazil.

DOI: 10.4236/jct.2015.63031                

Abstract

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of mortality among cirrhotic patients, and current guidelines recommend single-treatment modalities according to patient and liver disease classifications. New studies have shown promising results from combining locoregional and systemic treatments, but most of them were limited to Child-Pugh A patients due to toxicity concerns. Aim: The objective of this study was to analyze survival rates of Child-Pugh A and B patients with intermediate HCC tumors treated with transarterial chemoembolization (TACE) followed by full-dose sorafenib usage. Material and methods: a retrospective analysis of 37 cirrhotic patients (Child-Pugh A and B rates = 23/14) treated with TACE and TACE followed by sorafenib usage (17 and 20 patients, respectively). Results: The mean survival was 379 days in the combined treatment group and 151 days in the single-treatment group (p = 0.007). There were no differences in survival according to the Child-Pugh classification. Conclusions: sorafenib after TACE can be an option for selected cirrhotic patients with intermediate HCC tumors if this combined approach is cautiously performed on an individualized schedule. Our results suggest that the Child-Pugh classification should not be a limitation to this combined treatment.

Keywords

Hepatocellular Carcinoma, Cirrhosis, Arterial Chemoembolization, Sorafenib

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Gomaa, A.I., Khan, S.A., Tolledano, M.B., Waked, I. and Taylor-Robinson, S.D. (2008) Hepatocellular Carcinoma: Epidemiology, Risk Factors and Pathogenesis. World Journal of Gastroenterology, 14, 4300-4308. http://dx.doi.org/10.3748/wjg.14.4300
[2]	Lau, W.T. and Lai, E.C.H. (2008) Hepatocellular Carcinoma: Current Management and Recent Advances. Hepatobiliary & Pancreatic Diseases International, 7, 237-257.
[3]	Ferlay, J., Shin, H.R., Bray, F., Forman, D., Mathers, C. and Parkin, D.M. (2010) Estimates of Worldwide Burden of Cancer in 2008: GLOBOCAN 2008. International Journal of Cancer, 127, 2893-2917. http://dx.doi.org/10.1002/ijc.25516
[4]	Bruix, J., Sherman, M., Llovet, J.M., Beaugrand, M., Lencioni, R., Burroughs, A.K., et al. (2001) Clinical Managementof Hepatocellular Carcinoma: Conclusions of the Barcelona-2000 EASL Conference. Journal of Hepatology, 35, 421-430. http://dx.doi.org/10.1016/S0168-8278(01)00130-1
[5]	Gomaa, A.I., Hashim, M.S. and Waked, I. (2014) Comparing Staging Systems for Predicting Prognosis and Survival in Patients with Hepatocellular Carcinoma in Egypt. PLoS One, 9, e90929. http://dx.doi.org/10.1371/journal.pone.0090929
[6]	Bruix, J., Raoul, J.L., Sherman, M., Mazzaferro, V., Bolondi, L., Craxi, A., Galle, P.R., Santoro, A., Beaugrand, M., Sangiovanni, A., Porta, C., Gerken, G., Marrero, J.A., Nadel, A., Shan, M., Moscovici, M., Voliotis, D. and Llovet, J.M. (2012) Efficacy and Safety of Sorafenib in Patients with Advanced Hepatocellular Carcinoma: Subanalyses of a Phase III Trial. Journal of Hepatology, 57, 821-829. http://dx.doi.org/10.1016/j.jhep.2012.06.014
[7]	Kudo, M. and Ueshima, K. (2010) Positioning of a Molecular-Targeted Agent, Sorafenib, in the Treatment Algorithm for Hepatocellular Carcinoma and Implication of Many Complete Remission Cases in Japan. Oncology, 78(S1), 154-166. http://dx.doi.org/10.1159/000315245
[8]	Radu, P., Groza, I., Iancu, C., Al Hajjar, N., Andreica, V. and Sparchez, Z. (2013) Treatment of Hepatocellular Carcinoma in a Tertiary Romanian Center. Deviations from BCLC Recommendations and Influence on Survival Rate. Journal of Gastrointestinal and Liver Diseases, 22, 291-297.
[9]	Sansonno, D., Lauletta, G., Russi, S., Conteduca, V., Sansonno, L. and Dammacco, F. (2012) Transarterial Chemoembolization Plus Sorafenib: A Sequential Therapeutic Scheme for HCV-Related Intermediate-Stage Hepatocellular Carcinoma: A Randomized Clinical Trial. The Oncologist, 17, 359-366. http://dx.doi.org/10.1634/theoncologist.2011-0313
[10]	Liapi, E. and Geschwind, J.F. (2012) Combination of Local Transcatheter Arterial Chemoembolization and Systemic Antiangiogenic Therapy for Unresectable Hepatocellular Carcinoma. Liver Cancer, 1, 201-215. http://dx.doi.org/10.1159/000343835
[11]	Weintraub, J.L. and Salem, R. (2013) Treatment of Hepatocellular Carcinoma Combining Sorafenib and Transarterial Locoregional Therapy: State of the Science. Journal of Vascular and Interventional Radiology, 24, 1123-1134. http://dx.doi.org/10.1016/j.jvir.2013.01.494
[12]	Kim, H.Y. and Park, J.W. (2014) Clinical Trials of Combined Molecular Targeted Therapy and Locoregional Therapy in Hepatocellular Carcinoma: Past, Present, and Future. Liver Cancer, 3, 9-17. http://dx.doi.org/10.1159/000343854
[13]	Garwood, E., Fidelman, N., Hoch, S.E., Kerlan Jr., R.K. and Yao, F.Y. (2013) Morbidity and Mortality Following Transarterial Liver Chemoembolization in Patients With Hepatocellular Carcinoma and Synthetic Hepatic Dysfunction. Liver Transplantation, 19, 164-173. http://dx.doi.org/10.1002/lt.23552
[14]	Piscaglia, F., Terzi, E., Cucchetti, A., Trimarchi, C., Granito, A., Leoni, S., Marinelli, S., Pini, P. and Bolondi, L. (2013) Treatment of Hepatocellular Carcinoma in Child-Pugh B Patients. Digestive and Liver Disease, 45, 852-858. http://dx.doi.org/10.1016/j.dld.2013.03.002
[15]	Sieghart, W., Pinter, M., Reisegger, M., Müller, C., Ba-Ssalamah, A., Lammer, J. and Peck-Radosavljevic, M. (2012) Conventional Transarterial Chemoembolisation in Combination with Sorafenib for Patients with Hepatocellular Carcinoma: A Pilot Study. European Radiology, 22, 1214-1223. http://dx.doi.org/10.1007/s00330-011-2368-z