Sorafenib for Survival Post-progression in Advanced Hepatocellular Carcinoma Unresponsive to Hepatic Arterial Infusion Chemotherapy

Abstract

AIM: Hepatic arterial infusion chemotherapy (HAIC) has been used as a palliative treatment option for the treatment of advanced hepatocellular carcinoma (HCC) patients in Japan. However, no beneficial data regarding salvage options, including the use of sorafenib, are available for patients who are unresponsive to HAIC. METHODS: We retrospectively enrolled 67 consecutive HCC patients who had undergone HAIC with a fine-powder formulation of cisplatin. The primary evaluation criterion was survival postprogression (SPP), a surrogate for overall survival, among patients with progressive disease (PD) who received various post-HAIC salvage options. RESULTS: Among the 38 PD patients who had a Child-Pugh score 8 or less during HAIC, the median SPP was significantly longer for the 19 patients who received sorafenib, compared with those who received other salvage options (continuous HAIC for 5 patients; tegafur-uracil for 2; best supportive care for 12) (5.5 vs. 3.8 months; P=0.041). A multivariate analysis showed that sorafenib use (P=0.010) and the absence of ascites (P=0.003) had a superior statistical significance with regard to the SPP. CONCLUSIONS: Sorafenib may be beneficial as a salvage option in patients with advanced HCC who were unresponsive to HAIC using cisplatin powder. A further prospective study will be needed to validate these results in larger populations of patients.