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Lim CA, Amaro CP, Ding PQ, Cheung WY, Tam VC. Outcomes of hepatocellular carcinoma patients treated in the lenvatinib and immunotherapy era (2018-2021) compared to the sorafenib era (2008-2018). Cancer Med 2024; 13:e7415. [PMID: 38953381 PMCID: PMC11217803 DOI: 10.1002/cam4.7415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/29/2024] [Accepted: 06/08/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Lenvatinib (LEN) and atezolizumab + bevacizumab (A + B) have drastically changed the treatment paradigm for advanced hepatocellular carcinoma (HCC). Before these landmark trials, sorafenib (SOR) served as the standard first-line treatment for a decade. Our study aimed to assess the outcomes of HCC patients treated during the SOR era (2008-2018) in contrast to those in the post-SOR era (2018-2021), of which the predominant first-line treatments were LEN or A + B. METHODS Inclusion criteria of the study were all HCC patients in the Canadian province of Alberta who started first-line systemic therapy at cancer centers between 1 January 2008 and 31 December 2021. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), along with clinician-assessed response rate (RR), were subject to retrospective analysis. RESULTS Of 372 total patients, 230 received treatment in the SOR era and 142 in the post-SOR era. The demographic and clinical characteristics for the SOR era and post-SOR era groups are as follows, respectively: the median age was 63 and 64 years, 80% and 81% were male, and 24% and 11% were of East Asian ethnicity. Before receiving systemic treatment, 40% and 33% received TACE, 7% and 9% received TARE, and 3% and 14% received SBRT in the two eras, respectively. In the post-SOR era, patients received A + B (23%), LEN (51%), and SOR (23%) as first-line treatment. There was a statistically significant improvement in RR (15% vs. 26%; p = 0.02), median PFS (3.8 months vs. 7.9 months; p < 0.0001), and median OS (9.8 months vs. 17.0 months; p < 0.0001). CONCLUSIONS In this retrospective multicenter real-world study, HCC patients treated in the post-SOR era, where LEN and A + B were commonly used first-line treatments, exhibited superior OS, PFS, and RR compared to patients treated in the SOR era. The findings of this study affirm the tangible progress achieved in the real world in enhancing outcomes for HCC patients through advancements in treatments over the past 15 years.
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Affiliation(s)
- Chloe A. Lim
- Internal Medicine Residency Program, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Carla P. Amaro
- Tom Baker Cancer CentreUniversity of CalgaryCalgaryAlbertaCanada
| | - Philip Q. Ding
- Tom Baker Cancer CentreUniversity of CalgaryCalgaryAlbertaCanada
| | - Winson Y. Cheung
- Tom Baker Cancer CentreUniversity of CalgaryCalgaryAlbertaCanada
| | - Vincent C. Tam
- Tom Baker Cancer CentreUniversity of CalgaryCalgaryAlbertaCanada
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2
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Heumann P, Albert A, Gülow K, Tümen D, Müller M, Kandulski A. Insights in Molecular Therapies for Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:1831. [PMID: 38791911 PMCID: PMC11120383 DOI: 10.3390/cancers16101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
We conducted a comprehensive review of the current literature of published data and clinical trials (MEDLINE), as well as published congress contributions and active recruiting clinical trials on targeted therapies in hepatocellular carcinoma. Combinations of different agents and medical therapy along with radiological interventions were analyzed for the setting of advanced HCC. Those settings were also analyzed in combination with adjuvant situations after resection or radiological treatments. We summarized the current knowledge for each therapeutic setting and combination that currently is or has been under clinical evaluation. We further discuss the results in the background of current treatment guidelines. In addition, we review the pathophysiological mechanisms and pathways for each of these investigated targets and drugs to further elucidate the molecular background and underlying mechanisms of action. Established and recommended targeted treatment options that already exist for patients are considered for systemic treatment: atezolizumab/bevacizumab, durvalumab/tremelimumab, sorafenib, lenvatinib, cabozantinib, regorafenib, and ramucirumab. Combination treatment for systemic treatment and local ablative treatment or transarterial chemoembolization and adjuvant and neoadjuvant treatment strategies are under clinical investigation.
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Affiliation(s)
- Philipp Heumann
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany (K.G.); (D.T.)
| | | | | | | | | | - Arne Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany (K.G.); (D.T.)
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Cetinkaya A, Kaya SI, Alahmad W, Bellur Atici E, Ozkan SA. Designing an electrochemical sensor based on ZnO nanoparticle-supported molecularly imprinted polymer for ultra-sensitive and selective detection of sorafenib. Anal Chim Acta 2023; 1280:341866. [PMID: 37858567 DOI: 10.1016/j.aca.2023.341866] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sorafenib (SOR) is a multikinase inhibitor anticancer drug that is used in treating non-small cell lung cancer. In this work, we focused on developing nanomaterial-supported smart porous interfaces by following the molecular imprinting approach for the selective determination of SOR. Determination-based studies in the literature for SOR are limited, and they are chromatographic techniques-based; hence, there is a need in the literature to elaborate the selective and sensitive analysis/monitoring of SOR in both biological and pharmaceutical samples with more studies. RESULTS The results showed that adding ZnO NPs enhanced the signal five times compared to the solo molecularly imprinted polymer (MIP). Under the optimized conditions, ZnO/AMPS@MIP-GCE showed a linear response in the concentration range between 1.0 × 10-12 and 1.0 × 10-11 M with LOD and LOQ values of 2.25 × 10-13 M and 7.51 × 10-13 M, respectively, in the serum sample. The selectivity study was conducted against common cations, anions, and compounds such as dopamine, paracetamol, ascorbic acid, and uric acid. Also, the imprinting factor (IF) analysis was performed on selected drug substances having structural similarities to SOR and the relative IF values of regorafenib, leflunomide, teriflunomide, nilotinib, axitinib, and dasatinib indicated the selectivity of the developed sensor for SOR. Finally, ZnO/AMPS@MIP-GCE was implemented to determine SOR in the spiked commercial human serum samples and tablet dosage form with bias% between -0.43 and + 0.66. SIGNIFICANCE AND NOVELTY This study is the first electrochemical study for the determination of SOR, and thanks to the ZnO NPs supported MIP sensor, it stands out in terms of both high sensitivity and superior selectivity. Also, this designed sensor provides controlled orientation of the template and complete removal of templates in a one-step process, allowing extremely low detection and quantification limits.
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Affiliation(s)
- Ahmet Cetinkaya
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, 06560, Ankara, Turkiye; Ankara University, Graduate School of Health Sciences, Ankara, Turkiye
| | - S Irem Kaya
- University of Health Sciences, Gulhane Faculty of Pharmacy, Analytical Chemistry Department, Ankara, Turkiye.
| | - Waleed Alahmad
- Chulalongkorn University, Department of Chemistry, Faculty of Science, Bangkok, Thailand
| | - Esen Bellur Atici
- DEVA Holding A.Ş., R&D Center, Karaağaç Mh. Fatih Blv. No: 26, 59510, Kapaklı, Tekirdağ, Turkiye
| | - Sibel A Ozkan
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, 06560, Ankara, Turkiye.
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Lee MMP, Chan LL, Chan SL. The role of lenvatinib in the era of immunotherapy of hepatocellular carcinoma. JOURNAL OF LIVER CANCER 2023; 23:262-271. [PMID: 37589044 PMCID: PMC10565543 DOI: 10.17998/jlc.2023.07.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
Hepatocellular carcinoma (HCC) frequently presents as advanced stage with poor prognosis and high mortality. Systemic treatment is the treatment of choice for advanced disease. In 2007, the first multi-kinase inhibitor (MKI) sorafenib was approved and shown to modestly prolong overall survival (OS). The progress of systemic therapy has been slow afterwards until 2018 when lenvatinib, another MKI, was shown to be non-inferior to sorafenib on median OS as the first-line therapy for HCC. Since then, remarkable progress has been achieved on the treatment of advanced HCC, including the development of second-line targeted treatment, including regorafenib, cabozantinib and ramucirumab from 2017 to 2019. A growing focus has been placed on immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1), its ligand PD-L1, and cytotoxic T-lymphocyte-associated protein 4. These ICIs have proven their potency in treating HCC as both initial and subsequent line of therapy. At present, both regimens of atezolizumab combined with bevacizumab, as well as the combination of tremelimumab and durvalumab, are recommended as the first-line treatments based on positive phase III clinical trials. With the advancement of ICIs, it is anticipated that the role of MKIs in the treatment of HCC will evolve. In this article, lenvatinib, one of the most commonly used MKIs in HCC, is chosen to be reviewed.
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Affiliation(s)
- Matthew Man Pok Lee
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong Faculty of Medicine, Shatin, Hong Kong, China
| | - Landon Long Chan
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong Faculty of Medicine, Shatin, Hong Kong, China
| | - Stephen Lam Chan
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong Faculty of Medicine, Shatin, Hong Kong, China
- State Key Laboratory of Translational Oncology, State Key Lab & Research Institutes, Hong Kong Cancer Institute, The Chinese University of Hong Kong Faculty of Medicine, Shatin, Hong Kong, China
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Tomonari T, Tani J, Ogawa C, Deguchi A, Senoh T, Moriya A, Shibata H, Fukuno H, Tanaka H, Tanaka T, Taniguchi T, Sogabe M, Kawano Y, Morishita A, Takaguchi K, Miyamoto H, Sato Y, Masaki T, Takayama T. Multicenter retrospective study of initial treatment outcome and feasibility of initiating dose reduction of cabozantinib in unresectable hepatocellular carcinoma. Hepatol Res 2023; 53:172-178. [PMID: 36214071 DOI: 10.1111/hepr.13845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
AIM Cabozantinib (CAB), a multiple kinase inhibitor, has been approved for use in patients with previously treated unresectable hepatocellular carcinoma (uHCC). However, real-world clinical data are lacking, particularly clinical data regarding dose modifications of CAB. We analyzed the clinical outcomes of CAB in uHCC and compared treatment outcomes between the full- and reduced-dose groups. METHODS This multicenter, observational study included patients with uHCC who were treated with CAB from March 2021 to April 2022. Patient characteristics, efficacy, and safety were compared between the full- and reduced-dose groups. RESULTS Twenty-six patients from eight institutes were analyzed. Cabozantinib was administered as a third-line or later treatment in 25 (96.2%) patients and postimmunotherapy in 21 (80.5%) patients. There were 15 patients in the full-dose group (60 mg CAB) and 11 in the reduced-dose group (40 or 20 mg CAB). The objective response rate (ORR) and disease control rate (DCR) were not significantly different between the two groups. The ORR was 6.7% for the full-dose group and 9.1% for the reduced-dose group, and the DCR was 53.4% and 81.8%, respectively. Progression-free survival analysis showed no significant differences between the two groups. The incidence of decreased appetite, fatigue, and diarrhea, and the rate of discontinuation and dose reduction, was significantly higher in the full-dose group. CONCLUSIONS Our study suggests that the efficacy and safety of CAB in real-world clinical practice are comparable to those of the phase III trial (CELESTIAL), and that dose reduction of CAB may be a safer treatment option.
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Affiliation(s)
- Tetsu Tomonari
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Joji Tani
- Department of Gastroenterology and Neurology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Akihiro Deguchi
- Department of Gastroenterology, Kagawa Rosai Hospital, Marugame, Japan
| | - Tomonori Senoh
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Akio Moriya
- Department of Gastroenterology, Mitoyo General Hospital, Kanonji, Japan
| | - Hiroshi Shibata
- Department of Gastroenterology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Hiroshi Fukuno
- Department of Gastroenterology, Tokushima City Hospital, Tokushima, Japan
| | - Hironori Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takahiro Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tatsuya Taniguchi
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masahiro Sogabe
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yutaka Kawano
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Akihiro Morishita
- Department of Gastroenterology and Neurology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Koichi Takaguchi
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasushi Sato
- Department of Community Medicine for Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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O’Sullivan DE, Boyne DJ, Syed IA, Shephard C, Clouthier DL, Yoshida EM, Spratlin JL, Batra A, Rigo R, Hannouf M, Yang Hu X, N Jarada T, Brenner DR, Cheung WY. Real-world treatment patterns, clinical outcomes, and health care resource utilization in advanced unresectable hepatocellular carcinoma. CANADIAN LIVER JOURNAL 2022; 5:476-492. [PMID: 38144405 PMCID: PMC10735199 DOI: 10.3138/canlivj-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/28/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND: The incidence of advanced unresectable hepatocellular carcinoma (HCC) is increasing in developed countries and the prognosis of advanced HCC remains poor. Real-world evidence of treatment patterns and outcomes can highlight the unmet clinical need. METHODS: We conducted a retrospective population-based cohort study of patients with advanced unresectable HCC diagnosed in Alberta, Canada (2008-2018) using electronic medical records and administrative claims data. A chart review was conducted on patients treated with systemic therapy to capture additional information related to treatment. RESULTS: A total of 1,297 advanced HCC patients were included of whom 555 (42.8%) were recurrent cases and the remainder were unresectable at diagnosis. Median age at diagnosis was 64 (range 21-94) years and 82.1% were men. Only 274 patients (21.1%) received first-line systemic therapy and, of those, 32 patients (11.7%) initiated second-line therapy. Nearly all of the patients received sorafenib (>96.4%) in first-line, and these patients had considerably higher median survival (12.23 months; 95% CI 10.72-14.10) compared with patients not treated with systemic therapy (2.66 months; 95% CI 2.33-3.12; log-rank p <0.001). Among patients treated with systemic therapy, overall survival was higher for recurrent cases, patients with Child-Pugh A functional status, and patients with HCV or multiple known HCC risk factors (p <0.05). CONCLUSIONS: In a Canadian real-world setting, patients who received systemic therapy had greater survival than those who did not, but outcomes were universally poor. These results underscore the need for effective front-line therapeutic options.
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Affiliation(s)
- Dylan E O’Sullivan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, Alberta, Canada
| | - Devon J Boyne
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, Alberta, Canada
| | - Iqra A Syed
- AstraZeneca Canada, Mississauga, Ontario, Canada
| | - Cal Shephard
- AstraZeneca Canada, Mississauga, Ontario, Canada
| | | | - Eric M Yoshida
- Canadian Liver Foundation, Markham, Ontario, Canada
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer L Spratlin
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Atul Batra
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Rodrigo Rigo
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Malek Hannouf
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Xun Yang Hu
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tamer N Jarada
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, Alberta, Canada
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Pang Y, Eresen A, Zhang Z, Hou Q, Wang Y, Yaghmai V, Zhang Z. Adverse events of sorafenib in hepatocellular carcinoma treatment. Am J Cancer Res 2022; 12:2770-2782. [PMID: 35812068 PMCID: PMC9251699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 01/05/2023] Open
Abstract
Sorafenib is an oral multikinase inhibitor approved by the US Food and Drug Administration for treatment of the patients with surgically unresectable hepatocellular carcinoma (HCC). Sorafenib mitigates angiogenesis by targeting vascular endothelial growth factor receptors and platelet-derived growth factor receptors in endothelial cells and pericytes. Moreover, it suppresses cell proliferation via blockage of B-RAF and RAF1 of the mitogen-activated protein kinase pathway in tumor cells. Sorafenib has been the standard molecular targeted medication in the treatment of advanced-stage HCC patients ineligible for potentially curative interventional (radiofrequency or microwave ablation) or palliative trans-arterial chemoembolization (TACE) therapies for over a decade. However, it only increases overall survival by less than 3 months, and systemic exposure to sorafenib causes clinically significant toxicities (about 50% of patients). Given the high frequency and severity of these toxicities, sorafenib dose must be often reduced or discontinued altogether. In this review, we discussed the mechanism of sorafenib-associated adverse events and their management during HCC treatment.
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Affiliation(s)
- Yongsheng Pang
- Department of Radiological Sciences, University of California Irvine Irvine, CA, USA
| | - Aydin Eresen
- Department of Radiological Sciences, University of California Irvine Irvine, CA, USA
| | - Zigeng Zhang
- Department of Radiological Sciences, University of California Irvine Irvine, CA, USA
| | - Qiaoming Hou
- Department of Radiological Sciences, University of California Irvine Irvine, CA, USA
| | - Yining Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Vahid Yaghmai
- Department of Radiological Sciences, University of California Irvine Irvine, CA, USA.,Chao Family Comprehensive Cancer Center, University of California Irvine Irvine, CA, USA
| | - Zhuoli Zhang
- Department of Radiological Sciences, University of California Irvine Irvine, CA, USA.,Chao Family Comprehensive Cancer Center, University of California Irvine Irvine, CA, USA.,Department of Biomedical Engineering, University of California Irvine Irvine, CA, USA.,Department of Pathology and Laboratory Medicine, University of California Irvine Irvine, CA, USA
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8
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Gallage S, García-Beccaria M, Szydlowska M, Rahbari M, Mohr R, Tacke F, Heikenwalder M. The therapeutic landscape of hepatocellular carcinoma. MED 2021; 2:505-552. [DOI: 10.1016/j.medj.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
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Alghamdi MA, Amaro CP, Lee-Ying R, Sim HW, Samwi H, Chan KK, Knox JJ, Ko YJ, Swiha M, Batuyong E, Romagnino A, Cheung WY, Tam VC. Effect of sorafenib starting dose and dose intensity on survival in patients with hepatocellular carcinoma: Results from a Canadian Multicenter Database. Cancer Med 2020; 9:4918-4928. [PMID: 32529797 PMCID: PMC7367626 DOI: 10.1002/cam4.3228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Sorafenib has been shown to improve survival in patients with advanced hepatocellular carcinoma (HCC), however, full dose can be difficult to tolerate. The aim of this study was to determine whether sorafenib starting dose and mean dose intensity affect survival. Methods Patients treated with sorafenib for HCC from January 2008 to July 2016 in several Canadian provinces were included and retrospectively analyzed. The primary end point was overall survival (OS) of patients starting on sorafenib full dose compared to reduced dose. Secondary analysis compared OS with different mean dose‐intensity groups. Survival outcomes were assessed with Kaplan‐Meier curves and Cox proportional hazards models. A propensity score analysis was performed to account for treatment bias and confounding. Results Of 681 patients included, sorafenib was started at full dose in 289 patients (42%). Median survival for starting full and reduced dose was 9.4 months and 8.9 months (P = .15) respectively. After propensity score matching and adjusting for potential confounders there was still no difference in survival (HR 0.8, 95% CI, 0.61‐1.06, P = .12). Almost half of the patients (45%) received a dose intensity < 50%. Median survival for mean dose intensity > 75%, 50%‐75%, and < 50% were 9.5 months, 12.9 months, and 7.1 months (P = .005) respectively. In multivariable models, starting dose(HR 1.16, 95% CI 0.93‐1.44, P = .180) and mean dose intensity were not associated with survival. Conclusions Starting HCC patients on a reduced dose of sorafenib compared to full dose may not compromise survival. Mean dose‐intensity of sorafenib may also not affect survival.
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Affiliation(s)
- Mohammed A Alghamdi
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.,College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Carla P Amaro
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Richard Lee-Ying
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Hao-Wen Sim
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Haider Samwi
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kelvin K Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Jennifer J Knox
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Yoo-Joung Ko
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Mina Swiha
- University of Western Ontario, London, ON, Canada.,Menoufia University, Shebin El Kom, Egypt
| | - Eugene Batuyong
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Winson Y Cheung
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Vincent C Tam
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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