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TIPS plus sequential systemic therapy of advanced HCC patients with tumour thrombus-related symptomatic portal hypertension. Eur Radiol 2022; 32:6777-6787. [PMID: 35441840 PMCID: PMC9474440 DOI: 10.1007/s00330-022-08705-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/10/2022]
Abstract
Objectives Portal vein tumour thrombus (PVTT)–related symptomatic portal hypertension (SPH) leads to a poor prognosis in hepatocellular carcinoma (HCC) patients. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively relieve SPH but its effect remains unclear in PVTT-related SPH. This study aimed to evaluate the clinical value of the TIPS procedure combined with sequential systemic therapy in advanced HCC patients with PVTT-related SPH. Methods After 1:1 propensity score matching (PSM), this retrospective study analysed 42 patients who underwent TIPS placement plus sequential systemic therapy (group A) and 42 patients who received only symptomatic and supportive treatment (group B). The evaluated outcomes were overall survival (OS) and SPH control rate. Cox proportional hazards regression analysis was used to compare OS in the two groups. Results In group A, the technical success rate of the TIPS procedure was 95.2%, and no severe complications occurred. The rebleeding rates in group A and group B were 5.0% and 73.7%, respectively (p < 0.001), and the ascites control rates were 92.0% and 28.0%, respectively (p < 0.001). The median OS of group A was significantly better than that of group B (9.6 [95% CI: 7.1, 12.0] vs. 4.9 [95% CI: 3.9, 5.8], months, p < 0.001). Multivariable analysis showed that TIPS plus sequential systemic therapy (hazard ratio [HR] = 5.799; 95% CI: 3.177, 10.585; p < 0.001) was an independent prognostic factor related to OS. Additionally, PVTT degree (I+II) (p = 0.008), AFP ≤ 400 ng/ml (p = 0.003), and Child–Pugh class A (p = 0.046) were significant predictors of OS. Conclusion TIPS plus sequential systemic therapy is safe and feasible for treating advanced HCC with tumour thrombus-related SPH. Key Points • Portal vein tumour thrombus (PVTT) is common in advanced hepatocellular carcinoma (HCC) and transforms compensated portal hypertension into symptomatic portal hypertension (SPH). • HCC patients with PVTT-related SPH have a very poor prognosis, and there are no effective treatments recommended by the guidelines. • Therefore, a treatment strategy that utilises a transjugular intrahepatic portosystemic shunt (TIPS) to manage SPH combined with sequential systemic therapy in advanced HCC patients is explored in this study for its feasibility and clinical value. This research can fill the gap in current research data to provide clinically meaningful treatment options. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08705-7.
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Siddique O, Yoo ER, Perumpail RB, Perumpail BJ, Liu A, Cholankeril G, Ahmed A. The importance of a multidisciplinary approach to hepatocellular carcinoma. J Multidiscip Healthc 2017; 10:95-100. [PMID: 28360525 PMCID: PMC5365324 DOI: 10.2147/jmdh.s128629] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. The rising incidence, genetic heterogeneity, multiple etiologies, and concurrent chronic liver diseases make diagnosis, staging, and selection of treatment options challenging in patients with HCC. The best approach to optimize the management of HCC is one that utilizes a core multidisciplinary liver tumor board, consisting of hepatologists, pathologists, interventional radiologists, oncologists, hepatobiliary and transplant surgeons, nurses, and general practitioners. In most cases, HCC is diagnosed by abdominal imaging studies, preferably with a triphasic computed tomography scan of the abdomen or magnetic resonance imaging of the abdomen. Histopathological diagnosis using a guided liver biopsy may be needed in noncirrhotic patients or when radiological diagnostic criteria are not fulfilled in the setting of cirrhosis. The Barcelona Clinic Liver Cancer staging system facilitates a standardized therapeutic strategy based on the tumor burden, extent of metastasis, severity of hepatic decompensation, comorbid medical illnesses, functional status of patient, HCC-related symptoms, and preference of the patient. Treatment options include curative surgery (hepatic resection and liver transplantation) and palliative measures (radiofrequency ablation, transarterial chemoembolization, and chemotherapy with sorafenib). The role of the multidisciplinary team is crucial in promptly reconfirming the diagnosis, staging the HCC, and formulating an individualized treatment plan. In potential liver transplant candidates, timely liver transplant evaluation and coordinating bridging/downsizing treatment modalities, such as radiofrequency ablation and transarterial chemoembolization, can be time-consuming. In summary, a multidisciplinary team approach provides a timely, individualized treatment plan, which can vary from curative surgery in patients with early-stage HCC to palliative/hospice care in patients with metastatic HCC. In most tertiary care centers in the US, a multidisciplinary liver tumor board has become the standard of care and a key component of best practice protocol for patients with HCC.
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Affiliation(s)
- Osama Siddique
- Department of Medicine, Brown University, Providence, RI
| | - Eric R Yoo
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL
| | - Ryan B Perumpail
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | - Brandon J Perumpail
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Andy Liu
- Department of Medicine, California Pacific Medical Center, San Francisco, CA
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
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3
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Gadaleta-Caldarola G, Infusino S, Divella R, Ferraro E, Mazzocca A, De Rose F, Filippelli G, Abbate I, Brandi M. Sorafenib: 10 years after the first pivotal trial. Future Oncol 2016; 11:1863-80. [PMID: 26161924 DOI: 10.2217/fon.15.85] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Sorafenib is an oral multikinase inhibitor with anticancer activity against a wide spectrum of cancers. It is currently approved for the treatment of patients with hepatocellular carcinoma, advanced renal cell carcinoma or progressive, locally advanced or metastatic differentiated thyroid carcinoma. In this review, we present a number of studies that investigated the efficacy and safety of sorafenib in these settings. We also discuss the perspectives on the use of this molecule, including the role of sorafenib as comparator for the development of new drugs, the combination of sorafenib with additional therapies (such as transarterial chemoembolization for hepatocellular carcinoma) and the use of this treatment in several other advanced refractory solid tumors.
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Affiliation(s)
- Gennaro Gadaleta-Caldarola
- Medical Oncology Unit, 'Mons. R Dimiccoli' Hospital, Viale Ippocrate, 15, 76121 Barletta, Asl BAT, Italy
| | - Stefania Infusino
- Medical Oncology Unit, 'S Francesco di Paola' Hospital, Via Promintesta, 87027 Paola, ASP, Cosenza, Italy
| | - Rosa Divella
- Laboratory of Clinical and Experimental Pathology - National Cancer Institute 'Giovanni Paolo II', Viale Orazio Flacco 65, 70124, Bari, Italy
| | - Emanuela Ferraro
- Department of Internal Medicine & Clinical Specialties, University of Rome 'La Sapienza', Policlinico Umberto I, Viale del Policlinico, 155, 00161 Roma, Italy
| | - Antonio Mazzocca
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G Cesare, 11,70124 Bari, Italy, National Institute for Digestive Diseases, IRCCS 'Saverio De Bellis', Via Turi 27, 70013, Castellana Grotte, Bari, Italy
| | | | - Gianfranco Filippelli
- Medical Oncology Unit, 'S Francesco di Paola' Hospital, Via Promintesta, 87027 Paola, ASP, Cosenza, Italy
| | - Ines Abbate
- Laboratory of Clinical and Experimental Pathology - National Cancer Institute 'Giovanni Paolo II', Viale Orazio Flacco 65, 70124, Bari, Italy
| | - Mario Brandi
- Medical Oncology Unit, 'Mons. R Dimiccoli' Hospital, Viale Ippocrate, 15, 76121 Barletta, Asl BAT, Italy
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4
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Cabibbo G, Petta S, Maida M, Cammà C. Sorafenib for Hepatocellular Carcinoma: From Randomized Controlled Trials to Clinical Practice. Dig Dis 2015; 33:668-74. [PMID: 26398633 DOI: 10.1159/000438477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hepatocellular carcinoma is a challenging malignancy of global importance. It is the sixth most common solid malignancy and the third leading cause of cancer-related death, worldwide. Curative treatments at early stages include liver transplantation, resection and percutaneous ablation, while transarterial chemoembolization can improve survival in patients with intermediate tumor stage. Patients with mild, related symptoms and/or macrovascular invasion or extrahepatic spread are classified under the advanced stage. The standard of care in this group is sorafenib, an inhibitor of Raf kinase and vascular endothelial growth factor receptor, whose effectiveness has been proven by 2 recent randomized controlled trials (RCTs). The aim of this brief review is to highlight the main concerns and pitfalls and to analyze the recent data of literature regarding the efficacy and the management of sorafenib therapy from RCTs to real practice.
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Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy
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5
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Zhao Y, Qi X, He S, Han G. Letter: TIPSS in hepatocellular carcinoma. Aliment Pharmacol Ther 2015; 41:328. [PMID: 26146697 DOI: 10.1111/apt.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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6
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Yulyana Y, Ho IAW, Sia KC, Newman JP, Toh XY, Endaya BB, Chan JKY, Gnecchi M, Huynh H, Chung AYF, Lim KH, Leong HS, Iyer NG, Hui KM, Lam PYP. Paracrine factors of human fetal MSCs inhibit liver cancer growth through reduced activation of IGF-1R/PI3K/Akt signaling. Mol Ther 2015; 23:746-56. [PMID: 25619723 DOI: 10.1038/mt.2015.13] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/16/2014] [Indexed: 01/18/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death in the world. The multikinase inhibitor sorafenib only demonstrated marginal improvement in overall survival for advanced disease prompted the search for alternative treatment options. Human mesenchymal stem cells (MSCs) have the ability to home to tumor cells. However, its functional roles on the tumor microenvironment remain controversial. Herein, we showed that conditioned media derived from human fetal MSC (CM-hfMSCs) expressed high level of the insulin growth factor binding proteins IGFBPs and can sequester free insulin-like growth factors (IGFs) to inhibit HCC cell proliferation. The inhibitory effect of IGFBPs on IGF signaling was further evident from the reduction of activated IGF-1R and PI3K/Akt, leading eventually to the induction of cell cycle arrest. We also demonstrated that CM-hfMSCs could enhance the therapeutic efficacy of sorafenib and sunitinib. To the best of our knowledge, this is the first report to show that CM-hfMSCs has a tumor-specific, antiproliferative effect that is not observed with normal human hepatocyte cells and patient-derived matched normal tissues. Our results thus suggest that CM-hfMSCs can provide a useful tool to design alternative/adjuvant treatment strategies for HCC, especially in related function to potentiate the effects of chemotherapeutic drugs.
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Affiliation(s)
- Yulyana Yulyana
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | - Ivy A W Ho
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | - Kian Chuan Sia
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | - Jennifer P Newman
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | - Xin Yi Toh
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | - Berwini B Endaya
- Griffith University, Griffith Health Institute, School of Medical Science, Southport, Australia
| | - Jerry K Y Chan
- 1] Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore [2] Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore [3] Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
| | - Massimiliano Gnecchi
- 1] Department of Cardiothoracic and Vascular Sciences - Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Italy [3] Department of Medicine, University of Cape Town, South Africa
| | - Hung Huynh
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore
| | | | - Kiat Hon Lim
- Department of Pathology, Singapore General Hospital, Singapore
| | - Hui Sun Leong
- Division of Medical Sciences, National Cancer Centre, Singapore
| | | | - Kam Man Hui
- 1] Division of Cellular and Molecular Research, National Cancer Centre, Singapore [2] Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore [3] Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore [4] Institute of Molecular and Cell Biology, A*STAR, Proteos, Singapore
| | - Paula Y P Lam
- 1] Division of Cellular and Molecular Research, National Cancer Centre, Singapore [2] Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore [3] Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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7
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Simvastatin induces growth inhibition and apoptosis in HepG2 and Huh7 hepatocellular carcinoma cells via upregulation of Notch1 expression. Mol Med Rep 2014; 11:2334-40. [PMID: 25412322 DOI: 10.3892/mmr.2014.2976] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 10/27/2014] [Indexed: 11/05/2022] Open
Abstract
Statins, cholesterol‑lowering drugs, are one of the most commonly prescribed types of medications. Previous studies have suggested that simvastatin may inhibit the cell function and tumor growth of hepatocellular carcinoma (HCC) cells; however, the molecular mechanisms underlying simvastatin‑induced apoptosis in HCC cells remains to be elucidated. The aim of the present study was to investigate the role of simvastatin in the regulation of cell viability, proliferation and apoptosis in HepG2 and Huh7 HCC cells, and to elucidate the specific regulatory mechanisms by which simvastatin proceeds. MTT, trypan blue and flow cytometric analyses were performed in order to detect viability, proliferation and apoptosis in HepG2 and Huh7 cells. The results of the present study demonstrated that simvastatin significantly decreased cell viability and proliferation as well as increased apoptosis in HepG2 and Huh7 cells compared to that in untreated cells. In addition, reverse transcription quantitative polymerase chain reaction and western blot analysis revealed that simvastatin‑treated cells exhibited increased expression levles of Notch1, p53, and Bax, as well as decreased expression levels of B cell lymphoma 2; furthermore, Notch1 upregulation resulted in the inhibition of Akt phosphorylation. In conclusion, the results of the present study indicated that simvastatin significantly promoted apoptosis in HCC cells, the mechanism of which may have proceeded via the upregualtion of the Notch1 gene in the Akt‑dependent signaling pathway.
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8
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Bolondi L, Craxi A, Trevisani F, Daniele B, Di Costanzo GG, Fagiuoli S, Cammà C, Bruzzi P, Danesi R, Spandonaro F, Boni C, Santoro A, Colombo M. Refining sorafenib therapy: lessons from clinical practice. Future Oncol 2014; 11:449-65. [PMID: 25360997 DOI: 10.2217/fon.14.261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Understanding the best use of sorafenib is essential in order to maximize clinical benefit in hepatocellular carcinoma. Based on Phase III and noninterventional study data, as well as our extensive experience, we discuss dose modification in order to manage adverse events, disease response evaluation and how to maximize treatment benefit. Sorafenib should be initiated at the approved dose (400 mg twice daily) and reduced/interrupted as appropriate in order to manage adverse events. Dose modification should be considered before discontinuation. Appropriate tumor response assessment is critical. Focusing on radiologic response may result in premature sorafenib discontinuation; symptomatic progression should also be considered. If second-line therapies or trials are unavailable, continuing sorafenib beyond radiologic progression may provide a clinical benefit. Our recommendations enable the maximization of treatment duration, and hence clinical benefit, for patients.
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Affiliation(s)
- Luigi Bolondi
- Division of Internal Medicine, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital, Bologna, Italy
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9
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Sacco R, Sivozhelezov V, Pellegrini L, Giacomelli L, Longo V. Dietary supplementation in cancer patients: a personal view of current status and future perspectives. Future Oncol 2014; 10:1523-5. [PMID: 25145420 DOI: 10.2217/fon.14.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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10
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Sacco R, Gadaleta-Caldarola G, Galati G, Lombardi G, Mazza G, Cabibbo G. European Association for the Study of the Liver Hepatocellular Carcinoma summit 2014: old questions, new (or few) answers? Future Oncol 2014; 10:1719-21. [DOI: 10.2217/fon.14.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rodolfo Sacco
- Dipartimento di Gastroenterologia–Unità Ospedaliera Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy
| | | | | | | | | | - Giuseppe Cabibbo
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy
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11
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Liu L, Zhao Y, Qi X, Cai G, He C, Guo W, Yin Z, Chen H, Chen X, Fan D, Han G. Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension in hepatocellular carcinoma with portal vein tumor thrombosis. Hepatol Res 2014; 44:621-30. [PMID: 23679937 DOI: 10.1111/hepr.12162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/09/2013] [Accepted: 05/12/2013] [Indexed: 02/06/2023]
Abstract
AIM Transjugular intrahepatic portosystemic shunt (TIPS) represents a major advance in the treatment of complications of portal hypertension. However, this procedure is contraindicated in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). This study aims to evaluate the safety and efficacy of TIPS in these patients with portal hypertension and determine the predictors of survival after TIPS creation. METHODS Between 2005 and 2011, 58 consecutive HCC patients with symptomatic portal hypertension and concomitant PVTT underwent TIPS placement. Procedure-related complications, treatment efficacy of portal hypertension complications and survival were evaluated. RESULTS After TIPS, no patient experienced major procedure-related complications such as hemorrhage or contrast extravasation. Portosystemic pressure gradient was decreased by 14 mmHg on average. Refractory ascites was partially or completely resolved in 19 of 20 patients. Hydrothorax was decreased in all of eight patients. Acute variceal bleeding was successfully controlled in all of five patients. Severe diarrhea was controlled successfully in all of nine patients. During the follow-up period (mean, 78.5 days; range, 11-1713), 56 patients died and two patients remained alive. The median survival period after TIPS was 77 days. Multivariate Cox regression analysis showed that ascites (P = 0.026), white blood cell (P = 0.007) and degree of PVTT (P < 0.001) were independent predictors for survival. CONCLUSION TIPS may be effective for the palliative treatment of portal hypertension in HCC patients with PVTT. Major procedure-related complications were rarely observed. Ascites, white blood cell and degree of PVTT were independently associated with survival.
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Affiliation(s)
- Lei Liu
- Department of Liver Diseases and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases
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12
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Cabibbo G, Tremosini S, Galati G, Mazza G, Gadaleta-Caldarola G, Lombardi G, Antonucci M, Sacco R. Transarterial chemoembolization and sorafenib in hepatocellular carcinoma. Expert Rev Anticancer Ther 2014; 14:831-45. [PMID: 24850249 DOI: 10.1586/14737140.2014.920694] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transarterial chemoembolization (TACE) is considered as the standard therapy for patients with intermediate-stage hepatocellular carcinoma. However, given the high heterogeneity of this population, no common strategy or protocol standardization has been defined yet. In the last few years TACE treatment has been combined with sorafenib systemic therapy, reporting overall positive results both in terms of safety and efficacy. This systematic review presents and critically discusses the evidence available on the use of TACE in combination (concomitant or sequential) with sorafenib, focusing also on clinical trials currently ongoing to better define an optimal therapeutic strategy for this group of patients.
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Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology, DIBIMIS, University of Palermo, 90127 Palermo, Italy
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13
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Bargellini I, Scionti A, Mismas V, Masi G, Vivaldi C, Bartolozzi C, Sacco R. Identification of responders to sorafenib in hepatocellular carcinoma: is tumor volume measurement the way forward? Oncology 2014; 86:191-8. [PMID: 24800837 DOI: 10.1159/000358599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/20/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Early assessment of hepatocellular carcinoma (HCC) response during sorafenib (SO) treatment is challenging, since tumor necrosis, extension and radiological appearance can be inhomogeneous. We evaluated the predictive value of different imaging criteria - such as Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor density and volume variations - in the early follow-up of SO treatment. METHODS The study included 22 patients. CT images from baseline and 2 months were reviewed to assess response according to RECIST 1.1, mRECIST, EASL, Choi's criteria (decreased tumor density by ≥15%) and arterial-enhancing tumor volume ratio; α-fetoprotein (AFP) variations were expressed as AFP ratio. RESULTS The response criteria and volume measurements were reproducible (k > 0.80). The overall disease control rate was 40.9% by EASL and mRECIST, and 27.3% by RECIST 1.1; a ≥15% decrease in tumor density was observed in 9 patients (40.9%). The mean volume ratio was 1.73 ± 2.12, the mean AFP ratio 14 ± 37. The 1-year survival rate was 65.9%. Volume ratio was the only predictive factor for survival, with 1-year cumulative survival rates of 90% for volume ratios ≤1.1 and of 45.4% for volume ratios >1.1 (p = 0.04). CONCLUSIONS Tumor volume measurements are reproducible and might provide an early predictive marker of response in HCC patients treated with SO.
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Affiliation(s)
- Irene Bargellini
- Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Pisa, Italy
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14
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Cabibbo G, Maida M, Cammà C, Craxì A. Is the efficacy of sorafenib treatment in patients with hepatocellular carcinoma affected by age? Expert Rev Anticancer Ther 2013; 13:1355-61. [PMID: 24224926 DOI: 10.1586/14737140.2013.859989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cancer is a prevalent disease in the elderly population and hepatocellular carcinoma (HCC) is a major health problem among all tumors. Curative treatments for early-stage include liver transplantation, resection and percutaneous ablation. Transarterial chemoembolization (TACE) and sorafenib, classified as non-curative treatments, can improve survival for patients with intermediate and advanced tumors, respectively. Even if the incidence of HCC progressively increases with advanced age in all populations, reaching a peak at 70 years, few reports concerning correct management of HCC in elderly patients exist. Moreover, data from large randomized controlled trials (RCT) poorly reflect the elderly population that is often quantitatively and qualitatively underrepresented, as a result of the presence of tight enrolment criteria. The aim of this brief review is to highlight the main concerns, pitfalls and warnings regarding the management of HCC in elderly patients, with particular focus on systemic therapy with sorafenib.
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Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology, Di.Bi.Mi.S., University of Palermo, Italy
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15
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Moroni M, Zanlorenzi L. Complete regression following sorafenib in unresectable, locally advanced hepatocellular carcinoma. Future Oncol 2013; 9:1231-7. [PMID: 23902251 DOI: 10.2217/fon.13.86] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Sorafenib (SO) was the first targeted agent to produce significant improvements in overall survival in patients with advanced hepatocellular carcinoma (HCC). We report the case of a cirrhotic patient with chronic hepatitis C virus infection; locally advanced, unresectable, multinodular HCC, and portal vein tumor thrombosis, who achieved complete tumor regression following SO treatment. The patient was treated with SO 400 mg twice daily, which was subsequently reduced to 200 mg twice daily due to the occurrence of hand-foot skin reaction. The patient also received the following concomitant medications: Synchro-Levels(®) (Alphrema, Varese, Italy), silymarin and vitamin E. Long-term treatment with reduced SO dosage and Synchro-Levels resulted in a sustained radiological and clinical response with normalization of α-fetoprotein levels. Observed side effects were mostly low grade and manageable following dose adjustments. After 44 months of treatment the patient was in good physical condition, which suggests that a complete response with long-term SO is achievable in patients with locally advanced HCC.
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Affiliation(s)
- Marco Moroni
- U.O. Malattie Infettive, AO Ospedale di Circolo di Busto Arsizio, Ple Solaro 3, 21052 Busto Arsizio, Italy.
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16
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Barone C, Koeberle D, Metselaar H, Parisi G, Sansonno D, Spinzi G. Multidisciplinary approach for HCC patients: hepatology for the oncologists. Ann Oncol 2013; 24 Suppl 2:ii15-23. [PMID: 23715939 DOI: 10.1093/annonc/mdt053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a complex and heterogeneous disease, often associated with underlying conditions, like cirrhosis or other relevant co-morbidities that worsen the prognosis and make the clinical management more challenging. Current recommendations emphasize the importance of a multidisciplinary approach for the management of HCC patients and stress the crucial role of careful prevention and the management of cirrhosis-associated complications. This article discusses the importance of a multidisciplinary approach in the treatment of HCC patients. Current recommendations for the treatment of cirrhotic patients with HCC are also reviewed.
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Affiliation(s)
- C Barone
- Oncologia Medica, Università Cattolica del S. Cuore, Rome, Italy.
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17
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D'Angelo S, Secondulfo M, De Cristofano R, Sorrentino P. Selection and management of hepatocellular carcinoma patients with sorafenib: recommendations and opinions from an Italian liver unit. Future Oncol 2013; 9:485-91. [PMID: 23560372 DOI: 10.2217/fon.12.208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Sorafenib (SO) was the first systemic agent to demonstrate a significant improvement in overall survival in patients with advanced hepatocellular carcinoma (HCC); international guidelines now recommend SO as a first-line treatment in patients with unresectable HCC who are not eligible for locoregional therapies and maintain preserved liver function. However, therapy with SO may require close management to further optimize the clinical outcomes and limit the onset of adverse events (AEs). SO has been in use at our Liver Unit (Avellino, Italy) for over 4 years, and in that time 85 patients with HCC have been treated with SO. Here we describe how patients with HCC are managed with SO in our unit where management is based on three pivotal strategies: targeted patient selection; use of dose escalation to increase compliance and reduce AEs; and adoption of measures to prevent and manage AEs and to provide open access for patients.
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Affiliation(s)
- Salvatore D'Angelo
- Liver Unit, Clinical & Experimental Hepatology, Department of Internal Medicine, SG Moscati Hospital, Avellino, Avellino Contrada Amoretta 83100, Italy
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Genco C, Cabibbo G, Maida M, Brancatelli G, Galia M, Alessi N, Butera G, Genova C, Romano P, Raineri M, Giarratano A, Midiri M, Cammà C. Treatment of hepatocellular carcinoma: present and future. Expert Rev Anticancer Ther 2013; 13:469-79. [PMID: 23560841 DOI: 10.1586/era.13.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma is a major health problem. It is the sixth most common cancer worldwide and the third most common cause of cancer-related death. Despite the availability of several treatment opportunities, diagnosis is still made in an advanced phase, limiting application of most therapeutic choices that currently are based on the Barcelona Clinic Cancer Liver Classification and include surgical resection, orthotopic liver transplantation and ablative methods for very early and early disease, arterial chemoembolization for intermediate stages and systemic therapy with sorafenib for advanced hepatocellular carcinoma. Thanks to novel advancements in knowledge of molecular pathogenesis of this tumor, many new systemic agents and locoregional treatments are in different stages of clinical development and they represent an important promise of further improvements in patients' survival.
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Affiliation(s)
- Chiara Genco
- Section of Gastroenterology, DIBIMIS, University of Palermo, Palermo, Italy
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Cabibbo G, Maida M, Genco C, Parisi P, Peralta M, Antonucci M, Brancatelli G, Cammà C, Craxì A, Di Marco V. Natural history of untreatable hepatocellular carcinoma: A retrospective cohort study. World J Hepatol 2012; 4:256-61. [PMID: 23060970 PMCID: PMC3468702 DOI: 10.4254/wjh.v4.i9.256] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/20/2012] [Accepted: 08/23/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the clinical course of untreatable hepatocellular carcinoma (HCC) identified at any stage and to identify factors associated with mortality. METHODS From January 1999 to December 2010, 320 out of 825 consecutive patients with a diagnosis of HCC and not appropriate for curative or palliative treatments were followed and managed with supportive therapy. Cirrhosis was diagnosed by histological or clinical features and liver function was evaluated according to Child-Pugh score. The diagnosis of HCC was performed by Ultra-Sound guided biopsy or by multiphasic contrast-enhanced computed tomography or gadolinium-enhanced magnetic resonance imaging. Data were collected for each patient including all clinical, laboratory and imaging variables necessary for the outcome prediction staging systems considered. HCC staging was performed according Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program scores. Follow-up time was defined as the number of months from the diagnosis of HCC to death. Prognostic baseline variables were analyzed by multivariate Cox analysis to identify the independent predictors of survival. RESULTS Seventy-five per cent of patients had hepatitis C. Ascites was present in 169 patients (53%), while hepatic encephalopathy was present in 49 patients (15%). The Child-Pugh score was class A in 105 patients (33%), class B in 142 patients (44%), and class C in 73 patients (23%). One hundred patients (31%) had macroscopic vascular invasion and/or extra-hepatic spread of the tumor. A single lesion > 10 cm was observed in 34 patients (11%), while multinodular HCC was present in 189 patients (59%). Thirty nine patients (12%) were BCLC early (A) stage, 55 (17%) were BCLC intermediate (B) stage, 124 (39%) were BCLC advanced (C) stage, and 102 (32%) were end-stage BCLC (D). At the time of this analysis (July 2011), 28 (9%) patients were still alive. Six (2%) patients who were lost during follow-up were censored at the last visit. The overall median survival was 6.8 mo, and the 1-year survival was 32%. The 1-year survival according to BCLC classes was 100%, 79%, 12% and 0%, for BCLC A, B, C and D, respectively. There was a significant difference in survival between each BCLC class. The median survival of patients of BCLC stages A, B, C and D was 33, 17.4, 6.9, and 1.8 mo, respectively (P < 0.05 for comparison between stages). The median survival of Child-Pugh A, B and C classes were 9.8 mo (range 6.4-13), 6.1 (range 4.9-7.3), and 3.7 (range 1.5-6), respectively (P < 0.05 for comparison between stages). By univariate analysis, the variables significantly associated to an increased liklihood of mortality were Eastern Cooperative Oncology Group performance status (PS), presence of ascites, low level of albumin, elevated level of bilirubin, international normalized ratio (INR) and Log-[(α fetoprotein (AFP)]. At multivariate analysis, mortality was independently predicted by bad PS (P < 0.0001), high INR values (P = 0.0001) and elevated Log-(AFP) levels (P = 0.009). CONCLUSION This study confirms the heterogeneous behavior of untreated HCC. BCLC staging remains an important prognostic guide and may be important in decision-making for palliative treatment.
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Affiliation(s)
- Giuseppe Cabibbo
- Giuseppe Cabibbo, Marcello Maida, Chiara Genco, Pietro Parisi, Marco Peralta, Michela Antonucci, Giuseppe Brancatelli, Calogero Cammà, Antonio Craxì, Vito Di Marco, Section of Gastroenterology, Department of Internal Medicine and Biomedical Specialist, University of Palermo, Palermo 90127, Italy
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