Sorafenib for Treatment of Hepatocellular Carcinoma: A Survival Analysis from the South American Liver Research Network

Goals:We aim to describe the efficacy, safety profile, and variables associated with survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib in South America.Background:Sorafenib has been shown to improve survival in patients with advanced HCC. There are few data on sorafenib use for HCC in South America.Study:We performed a retrospective analysis of HCC cases treated with sorafenib from 8 medical centers in 5 South American countries, between January 2010 and June 2017. The primary endpoint was overall survival (OS), which was defined as time from sorafenib initiation to death or last follow-up. Risk factors for decreased OS were assessed using Cox proportional hazard regression and log-rank tests.Results:Of 1336 evaluated patients, 127 were treated with sorafenib and were included in the study. The median age of individuals was 65 years (interquartile range, 55 to 71) and 70% were male individuals. Median OS in all patients was 8 months (interquartile range, 2 to 17). Variables associated with survival on multivariate analysis were platelets >//<250,000 mm3 were also independently associated with survival (2 vs. 5.5 mo, P=0.03). Patients lived longer if they experienced any side effects from sorafenib use (11 vs. 2 mo, P=0.009). Patients who stopped sorafenib because of side effects had shorter survival compared with patients who were able to tolerate side effects and continue treatment (7.5 vs. 13 mo, P=0.01).Conclusions:Pretreatment elevation of platelets and advanced BCLC stage were independently associated with poor survival on sorafenib in a South American cohort.Fil: Leathers, James S.. Vanderbilt University School Of Medicine; Estados UnidosFil: Balderramo, Domingo. Instituto Universitario de Ciencias Biomédicas de Córdoba; ArgentinaFil: Prieto, John. Centro de Enfermedades Hepáticas y Digestivas; ColombiaFil: Diehl, Fernando. Instituto Universitario de Ciencias Biomédicas de Córdoba; ArgentinaFil: Gonzalez Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Ferreiro, Melina R.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Carrera, Enrique. Hospital Eugenio Espejo; EcuadorFil: Barreyro, Fernando Javier. Universidad Nacional de Misiones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Diaz-Ferrer, Javier. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Singh, Dupinder. University of Minnesota; Estados UnidosFil: Mattos, Angelo Z.. Universidade Federal de Ciencias Da Saúde de Porto Alegre; BrasilFil: Carrilho, Flair. Universidade de Sao Paulo; BrasilFil: Debes, Jose D.. University of Minnesota; Estados Unido

PIB: A score to select sorafenib treatment candidates for hepatocellular carcinoma in resource-limited settings

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death globally. Sorafenib, a multi-tyrosine kinase inhibitor, remains the standard of care for patients with inoperable or advanced-stage HCC. In resource-limited settings without access to surgical or locoregional therapy, sorafenib may be the only option for treating HCC. However, due to a modest survival benefit, as well as the limiting cost of sorafenib in certain regions, appropriate selection of patients for treatment is essential. Evaluation of Barcelona Clinic Liver Cancer (BCLC) criteria in resource-limited settings is frequently unachievable due to a variety of reasons. Using a cohort from the South American liver research network (1336 HCC cases), we created a cost-effective prognostic scoring system to help identify patients likely to have a survival benefit on sorafenib treatment, using simple laboratory variableFil: Leathers, James S.. Vanderbilt University; Estados UnidosFil: Balderramo, Domingo. Universidad de Córdoba; EspañaFil: Prieto, Jhon. Centro de Enfermedades Hepáticas y Digestivas; ColombiaFil: Diehl, Fernando. Universidad de Córdoba; EspañaFil: Gonzalez-Ballerga, Esteban. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Ferreiro, Melina R.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Carrera, Enrique. Hospital Eugenio Espejo; EcuadorFil: Barreyro, Fernando Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Diaz Ferrer, Javier. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Singh, Dupinder. University of Minnesota; Estados UnidosFil: Mattos, Angelo Z.. Universidade Federal de Ciencias Da Saúde de Porto Alegre; BrasilFil: Carrilho, Flair. Universidade de Sao Paulo; BrasilFil: Debes, Jose D.. University of Minnesota; Estados Unido