Survival Outcomes of Metastatic/Unresectable Hepatocellular Carcinoma in Patients Treated with Sorafenib
Chantharasamee J, MD1, Chotiyaputta W, MD2, Nimmannit A, MD3, Techawatanawanna S, MD1
Affiliation : 1 Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 3 Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Keywords : HCC, Hepatocellular carcinoma, HCC, metastasis, Outcome, Sorafenib, Unresectable
