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Iavarone M, Invernizzi F, Czauderna C, Sanduzzi-Zamparelli M, Bhoori S, Amaddeo G, Manini MA, López MF, Anders M, Pinter M, Rodríguez MJB, Cristóbal MR, Soteras GA, Piñero F, Villadsen GE, Weinmann A, Crespo G, Mazzaferro V, Regnault H, Giorgio MD, González-Diéguez ML, Donato MF, Varela M, Wörns MA, Bruix J, Lampertico P, Reig M. Preliminary experience on safety of regorafenib after sorafenib failure in recurrent hepatocellular carcinoma after liver transplantation. Am J Transplant 2019; 19:3176-3184. [PMID: 31365177 DOI: 10.1111/ajt.15551] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 02/06/2023]
Abstract
Regorafenib is one option for second-line treatment of hepatocellular carcinoma (HCC), improving overall survival (OS) of sorafenib-tolerant patients who develop progression. We aim to evaluate the safety and outcomes of regorafenib as second-line treatment for HCC recurrence after liver transplantation (LT). This is a retrospective, multicenter, international study including regorafenib-treated LT patients (2015-2018), with analysis of baseline characteristics and evolutionary events during sorafenib/regorafenib treatment. Twenty-eight LT patients (57 years, 7% cirrhotics, 54% performance status 1) were included. Median time from LT to regorafenib initiation was 3.9 (1.1-18.5) years; median time on sorafenib was 11.3 (0.7-76.4) months and 14 (1-591) days from sorafenib discontinuation to regorafenib. During regorafenib (6.3 months), all patients had at least one adverse event (AE), the most common grade 3/4 AEs were fatigue (n = 7) and dermatological reaction (n = 5). While no liver rejection was observed, plasma levels of immunosuppressive drugs increased in five. Twenty-four patients developed progression (38% extrahepatic growth, 33% new extrahepatic lesions/vascular invasion). Median OS from regorafenib initiation was 12.9 (95% CI, 6.7-19.1) and 38.4 months (95% CI, 18.5-58.4) for the sorafenib initiation. This is the first study showing safety of regorafenib after LT, thus providing the rational of considering regorafenib in the clinical decision-making in sorafenib-tolerant patients with HCC recurrence after LT.
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Affiliation(s)
- Massimo Iavarone
- AM& A Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, University of Milan, Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Federica Invernizzi
- AM& A Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, University of Milan, Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Carolin Czauderna
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marco Sanduzzi-Zamparelli
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Sherrie Bhoori
- G.I. Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuliana Amaddeo
- Service d'Hepatologie, Hopital Henri Mondor, Equipe 18, INSERM U955, Virus Immunité Cancer, Créteil, France
| | - Matteo A Manini
- Gastroenterology, Hepatology and Transplant Unit, Departement of Specialty and Transplant Medicine Azienda, Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Miguel F López
- Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Margarita Anders
- Unidad de Hepatología y Trasplante Hepático, Hospital Aleman, Buenos Aires, Argentina
| | - Matthias Pinter
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Federico Piñero
- Latin American Liver Research Educational and Awareness Network (LALREAN), Hospital Universitario Austral, School of Medicine, Argentina, Buenos Aires, Argentina
| | - Gerda E Villadsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Gonzalo Crespo
- Liver Transplant Unit, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Vincenzo Mazzaferro
- G. I. Surgery and Liver Trasplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Helene Regnault
- Service d'Hepatologie, Hopital Henri Mondor, Equipe 18, INSERM U955, Virus Immunité Cancer, Créteil, France
| | - Massimo De Giorgio
- Gastroenterology, Hepatology and Transplant Unit, Departement of Specialty and Transplant Medicine Azienda, Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Maria F Donato
- AM& A Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, University of Milan, Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Maria Varela
- Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Pietro Lampertico
- AM& A Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, University of Milan, Fondazione IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Maria Reig
- Barcelona Clinic Liver Cancer Group, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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