J Liver Cancer.  2019 Sep;19(2):117-127. 10.17998/jlc.19.2.117.

An Analysis for Survival Predictors for Patients with Hepatocellular Carcinoma Who Failed to Sorafenib Treatment in Pre-regorafenib Era

• Lee CU
• Lee YS
• Kim JH
• Lee M
• Kim S
• Jung YK
• Seo YS
• Yim HJ
• Yeon JE
• Byun KS

• KMID: 2463612
• DOI: http://doi.org/10.17998/jlc.19.2.117

Abstract

BACKGROUND/AIMS
Sorafenib is the standard treatment for patients with advanced hepatocellular carcinoma (HCC). We aimed to investigate the prognosis predictors and the role of second-line cytotoxic systemic chemotherapy (CSC) in patients with advanced HCC after sorafenib discontinuation in the pre-regorafenib era.
METHODS
From 2007 to 2015 in the pre-regorafenib era, the medical records of 166 HCC patients, who had permanently discontinued sorafenib, were retrospectively reviewed. For further analysis of survival factors after sorafenib treatment failure, we compared the survival of patients who had maintained liver function after second-line treatment with the best supportive care (BSC) group and selective BSC (SBSC) group.
RESULTS
After discontinuation of sorafenib, median overall survival (OS) was 2.8 (1.9-3.7) months. The OS in patients who discontinued sorafenib due to adverse effect, progression, and poor clinical condition were 5.5 (2.4-8.6), 5.5 (2.2-8.9), and 0.9 (0.5-1.3) months, respectively (P<0.001). The independent predictive factors of survival after sorafenib failure were serum level of bilirubin and albumin, α-fetoprotein, discontinuation cause, and second-line CSC. In comparison with survival between second-line CSC and BSC group, the CSC group showed better survival outcome compared to the BSC group (10.6 vs. 1.6 months, P<0.001) and SBSC group (10.6 vs. 4.2 months, P=0.023).
CONCLUSIONS
The survival after sorafenib failure in patients who discontinued sorafenib due to progression and adverse effects was significantly better than in those who discontinued treatment due to clinical deterioration. In the pre-regorafenib era, patients who received second-line CSC showed better survival than those who received only supportive care after sorafenib failure.

Keyword

Hepatocellular carcinoma; Sorafenib; Chemotherapy

MeSH Terms

Bilirubin
Carcinoma, Hepatocellular*
Drug Therapy
Humans
Liver
Medical Records
Prognosis
Retrospective Studies
Treatment Failure
Bilirubin

Figure

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  Figure 1. Flow diagram for study assessment. Initially, 1,635 reports were searched through the database and other sources. Only 25 studies were enrolled af ter evaluation. HCC, hepatocellular carcinoma; ECOG, Eastern Cooperative Oncology Group; TACE, transcatheter arterial chemoembolization.

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  Figure 2. Kaplan-Meier curve of all patients that discontinue sorafenib permanently.

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  Figure 3. Kaplan-Meier curve of decompensation group (red), progression group (blue), and adverse event group (green). AE, adverse event.

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  Figure 4. Kaplan-Meier analysis of overall survival (OS). (A) Median OS was 1.63 months in the best supportive care group (red) and 10.57 months in second-line chemotherapy group (blue). (B) Median OS was 4.34 months in the selective best supportive care group (red) and 10.57 months in second-line chemotherapy group (blue). BSC, best supportive care; CTx., chemotherapy.

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