Implementation of sorafenib treatment for advanced hepatocellular carcinoma: an illustration of current practice in Taiwan

Abstract

Background: Sorafenib is the first regimen listed in the treatment algorithm for hepatocellular carcinoma (HCC) worldwide. This study aimed to assess the efficacy of sorafenib treatment for advanced HCC in a clinical practice using a nationwide population study.

Methods: All patients registered with a diagnosis of primary HCC and identified as having been prescribed sorafenib between August 2012 and December 2015 were selected from a national database and retrospectively reviewed. Outcomes related to prescription of sorafenib for these patients were further assessed.

Results: A total of 9,738 patients were enrolled and analyzed. As a result, 32.33% of patients had an initial treatment response and were eligible for the prescribed second term (240 tablets/ term) of sorafenib and 8.91% of patients received more than three terms of sorafenib. Meanwhile, the duration of sorafenib usage beyond 6 months was noted in 15.49% of patients, including 10.59% of patients with a period of usage between 6 and 12 months and 4.9% of patients with more than 12 months usage. Survival analysis showed that patients who received locoregional therapy plus sorafenib had significantly better survival rates than those who underwent only sorafenib treatment. Certain patients who underwent hepatectomy (n=12) or liver transplantation (n=13) were subsequently free of HCC.

Conclusion: The disease control rate of sorafenib in advanced HCC patients in this study seemed similarly poorer as what has been previously reported by clinical trials. The combination of sorafenib and additional treatments could perhaps provide survival benefits and possibly cure disease in combination with surgical management.

Keywords: hepatectomy; hepatocellular carcinoma; liver transplantation; locoregional therapy; outcome; sorafenib.

Figure 1

Kaplan–Meier plots of time to discontinuation of sorafenib for all patients.

Figure 2

Kaplan–Meier plots of overall survival for all patients.

Figure 3

Comparison of Kaplan–Meier cumulative overall survival curves based on additional locoregional therapy. Group 1, patients had received sorafenib and additional locoregional therapy. Group 2, patients had only sorafenib treatment (P<0.0001).

Figure 4

Kaplan–Meier survival curves in patients based on additional locoregional therapy after propensity score matching. The outcomes of patients who had received additional locoregional therapy were also significantly better than those of patients who had only given sorafenib treatment. Group 1, patients had received sorafenib and additional locoregional therapy. Group 2, patients had only sorafenib treatment (P<0.0001).