Survival outcomes of metastatic/unresectable hepatocellular carcinoma in patients treated with sorafenib

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF Thailand 2019 Background: Hepatocellular carcinoma (HCC) is a common cancer in the Asia-Pacific region due to the high incidence of chronic viral hepatitis B (HBV) in the region. Several studies have reported a lower survival rate among patients in the Asia-Pacific region compared to patients in North America, possibly due to sorafenib being less efficacious in an Asian HBV population. There is no survival data available for patients in Thailand. Materials and Methods: We retrospectively reviewed the clinical outcomes of 83 metastatic/unresectable HCC patients treated between January 2008 and September 2013 with sorafenib and compared their survival with different prognostic factors. Results: In total, 83 patients were identified who had started treatment for metastatic/unresectable HCC with sorafenib. The median age of the patients was 56 years, and 85% were male. Fifty-one percent of the patients had extra-hepatic disease at the time sorafenib was indicated. Chronic HBV was found in 68% of the patients. The most common reason for discontinuation of treatment was progressive disease. The most frequently occurring grade 3 toxicities were hand-foot-syndrome (9.6%) and diarrhea (7.2%). The median overall survival was 6.3 months (95% confidence interval [CI] 3.15 to 9.15). The 6-month overall survival rate was 53%, while the median progression-free survival was 2.88 months (95% CI 2.20 to 3.45). We identified that macro-vascular invasion, elevation of alanine aminotransferase (ALT), serum alkaline phosphatase above the normal limit, serum albumin level below 3.5 g/ dL, lesions in both lobes of the liver, and total bilirubin greater than 1.5 mg/dL were related to poorer overall survival. Conclusion: The clinical outcome and toxicities profiles of sorafenib used among patients in Thailand are consistent with the previous large randomized controlled studies reported in the literature. Sorafenib is an appropriate treatment for HCC and is well tolerated by patients.