Can Sorafenib After TACE Improve Locoregional Control?
Patients who received sorafenib early after TACE for unresectable hepatocellular carcinoma (HCC) generally tolerated the treatment and had significant improvements in time to progression (TTP), according to a study published in Molecular and Clinical Oncology.
This prospective study evaluated the efficacy and safety of sorafenib therapy within 3 weeks after a second TACE treatment was performed due to recurrence within 6 months of the first TACE treatment for unresectable HCC. If patients who received TACE for HCC had disease progression within a 6-month period, they were given 400 to 800 mg of oral sorafenib once to twice daily within the 3 weeks after a second TACE treatment. Researchers calculated response to treatment, TTP, overall survival, and adverse events among patients.
There were 113 patients who underwent initial TACE for unresectable HCC between January 1995 and January 2013. TACE alone was given to 23 of these patients, and these patients had less than 6 months of time between the second and third TACE treatments. TTP was calculated between the third and fourth TACE treatments, and TTP was compared among patient groups. The groups were patients who were treated with sorafenib after TACE for >4 or <4 months, and patients who received TACE alone. During a median follow-up period of 34.4 months in both groups receiving sorafenib after TACE, sorafenib was linked with longer TTP and overall survival.
Additionally, the results showed that that sorafenib administration for >4 months significantly increased TTP (5.7 months) vs sorafenib for <4 months (3.0 months). Patients in the TACE alone group had a median TTP of 4.3 months between the third and fourth TACE treatments. Among the 3 groups, there was a decrease in TTP in the following order: sorafenib for >4 months, TACE alone, and sorafenib for <4 months. There was no significant difference in overall survival between patients treated with sorafenib for <4 or >4 months.
The researchers observed three grade 3 adverse events during the study.
“This clinical study was useful because of its prospective nature, as many previous reports have used a retrospective design,” the authors wrote, while noting that the study was not a randomized placebo-controlled trial and that the sample size was small. “Further studies are required to confirm the safety and efficacy of this combination therapy,” they concluded.
Tamai T, Kumagai K, Sakae H, et al. Early sorafenib induction after transarterial chemoembolization for unresectable hepatocellular carcinoma: Can sorafenib after TACE improve loco-regional control? Mol Clin Oncol. 2017 Dec; 7(6): 1135–1141.