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Sorafenib Plus Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma


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During the past decade, scientists began to test whether the addition of transarterial chemoembolization (TACE) to treatment with sorafenib could increase survival in patients with advanced hepatocellular carcinoma. Scientists from Taiwan and Japan performed the first large, national-level, population-based cohort study examining the influence of TACE on the effectiveness of sorafenib against liver cancer. Their findings were published by Kok et al in Cancers.

Lead study author Victor Kok, MMedSc, MD, PhD, FACP, explained, “Real-world data for this treatment combination is long overdue, and here we aimed to provide empirical evidence on whether sorafenib plus TACE is actually more effective than sorafenib alone. Our work can fuel further research aimed at understanding the molecular mechanisms underlying any synergistic effects of sorafenib and TACE.”

Methods

Researchers obtained data on patients with hepatocellular carcinoma from the Taiwan National Health Insurance Research Database, which is representative of Taiwan's population (99.9% of the island's population is enrolled in national health insurance). The scientists also used propensity matching to eliminate confounding factors (eg, patient age, sex, socioeconomic status) that may affect between-group differences in survival beyond the effects of sorafenib and TACE. Their cohort included 3,764 patients; 83% were men, and the median age was 60 years.

Patients were then classified into two groups: those who had received sorafenib plus TACE (n = 426) and those who received sorafenib alone (n = 1,686). Patients were followed until death or the end of the study.

KEY POINTS

  • Researchers identified a 26% decrease in mortality when TACE was added to sorafenib treatment compared with sorafenib treatment alone.
  • 6 months and 1 year after treatment, median overall survival was 80.3% and 53.5%, respectively, in the patients treated with sorafenib plus TACE vs 54.4% and 32.4% in patients treated with sorafenib alone.

Findings

The researchers identified a 26% decrease in mortality when TACE was added to sorafenib treatment compared with sorafenib treatment alone. More specifically, 6 months and 1 year after treatment, median overall survival was 80.3% and 53.5%, respectively, in the patients treated with sorafenib plus TACE vs 54.4% and 32.4% in patients treated with sorafenib alone. The improvement was present regardless of whether patients received one session of TACE or more. Additionally, median overall survival among the patients treated with sorafenib alone was similar to what other researchers found in the only other clinical trial that had a comparable population, suggesting that sorafenib's anticancer effects are consistent. The combination was well tolerated, because adverse events occurred at similar rates between patients treated with sorafenib alone or with sorafenib plus TACE.

Dr. Kok said in a statement, “Right now, oncologists aren't necessarily offering TACE as a treatment option because the evidence for its effectiveness isn't fully developed. But here, we've used a very large data set to show that TACE can be added to a sorafenib-based treatment and improve its outcome. We're hoping that this will signal an advancement in liver cancer therapy, while also encouraging more research on the molecular mechanisms of exactly how sorafenib synergizes with TACE to control liver tumors. A better understanding of the underlying processes responsible for this additive, positive effect could help us identify further treatments.”

Disclosure: For full disclosures of the study authors, visit mdpi.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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