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. 2011 Mar;4(2):40-4.

Safety and Efficacy of Sorafenib in Patients with Hepatocellular Carcinoma (HCC) and Child-Pugh A versus B Cirrhosis

Ghassan K Abou-Alfa, Dino Amadori, Armando Santoro, Arie Figer, Jacques De Greve, Chetan Lathia, Dimitris Voliotis, Sibyl Anderson, Marius Moscovici, Sergio Ricci

Safety and Efficacy of Sorafenib in Patients with Hepatocellular Carcinoma (HCC) and Child-Pugh A versus B Cirrhosis

Ghassan K Abou-Alfa et al. Gastrointest Cancer Res. 2011 Mar.

Abstract

Background: We performed a retrospective analysis of data from a phase II study evaluating sorafenib in patients with advanced hepatocellular carcinoma (HCC) to assess differences in safety and efficacy based on Child-Pugh (CP) status (A/B).

Methods: Patients received sorafenib 400 mg PO bid. We analyzed safety, pharmacokinetic (PK), and efficacy data in the two CP groups.

Results: Ninety-eight patients were CP A; 38 were CP B, with a median duration of therapy of 4 and 1.8 months, respectively. Grade 3/4 adverse events in the CP A and B groups, respectively, included hyperbilirubinemia (14% and 53%), ascites (3% and 5%), and encephalopathy (3% and 13%). Median overall survival (OS) in the CP A group was 9.5 months, compared with 3.2 months in the CP B population. Responses were limited in both groups. AUC and C(max) values were comparable between the two groups.

Conclusions: Due to the lack of randomization against placebo or no therapy in this study, it is unclear if the more frequent worsening of liver cirrhosis and outcome of CP B patients are drug related or due to disease progression, or both. As expected, outcome was poorer in patients with CP B than in those with CP A cirrhosis. The hyperbilirubinemia seen in both groups may be at least partly related to inhibition of UGT1A1 by sorafenib. PK profiles were similar in the two groups. More data are needed to confirm and more fully understand the safety and efficacy of sorafenib in patients with advanced HCC and CP B cirrhosis.

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Figures

Figure 1.
Figure 1.
Waterfall plot showing degree of tumor shrinkage in patients with stable disease in the Child-Pugh (CP) A and CP B groups.
Figure 2.
Figure 2.
Geometric mean plasma concentrations of sorafenib following administration of 400 mg bid in patients with advanced hepatocellular carcinoma and either Child-Pugh (CP) A or CP B hepatic impairment.
Figure 3.
Figure 3.
Proposed schema for a randomized, phase II study to evaluate the safety and efficacy of sorafenib in patients with HCC and advanced cirrhosis.
See this image and copyright information in PMC

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