Impact of age on sorafenib outcomes in hepatocellular carcinoma: an international cohort study.

BACKGROUND: There is no consensus on the effect of sorafenib dosing on efficacy and toxicity in elderly patients with hepatocellular carcinoma (HCC). Older patients are often empirically started on low-dose therapy with the aim to avoid toxicities while maximising clinical efficacy. We aimed to verify whether age impacts on overall survival (OS) and whether a reduced starting dose impacts on OS or toxicity experienced by the elderly. METHODS: In an international, multicentre cohort study, outcomes for those aged 7 cm) (39 vs 33%, p < 0.01) with preserved liver function (67 vs 57.7%) (p < 0.01). No difference in the median OS of those aged ≥75 years and <75 was noted (7.3 months vs 7.2 months; HR 1.00 (95% CI 0.93-1.08), p = 0.97). There was no relationship between starting dose of sorafenib 800 mg vs 400 mg/200 mg and OS between those <75 and ≥75 years. The elderly experienced a similar overall incidence of grade 2-4 sorafenib-related toxicity compared to <75 years (63.5 vs 56.7%, p = 0.11). However, the elderly were more likely to discontinue sorafenib due to toxicity (27.0 vs 21.6%, p < 0.01). This did not vary between different starting doses of sorafenib. CONCLUSIONS: Clinical outcomes in the elderly is equivalent to patients aged <75 years, independent of dose of sorafenib prescribed

Correction: Impact of age on sorafenib outcomes in hepatocellular carcinoma: an international cohort study.

A Correction to this paper has been published: https://doi.org/10.1038/s41416-020-01241-5</jats:p

Recurrent Vascular Events and Mortality Outcomes in Patients with Known Atrial Fibrillation, Compared to Atrial Fibrillation Detected Early after Stroke.

Abstract Introduction: Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients. Patients and methods: We used data (2015-2019) from a national prospective stroke registry of consecutive patients with acute ischemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: 1) all-cause mortality; 2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: 1) recurrent stroke; 2) functional outcome at discharge; 3) presence of co-existing stroke mechanisms. Results: 583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio [aHR] 1.56, 95% CI 1.12-2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio [aOR] 2.28, CI 1.14-4.59), but not poor functional outcome (aOR 1.61, CI 0.98-2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, CI 0.67-12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank P=0.03). Discussion and Conclusion: These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality