Christine Koch1,2, Markus Göller1, Eckart Schott3, Oliver Waidmann1,2, Mark Op den Winkel4, Philipp Paprottka4,5, Stephan Zangos6,7, Thomas Vogl6, Wolf Otto Bechstein8, Stefan Zeuzem1, Frank T Kolligs4,9, Jörg Trojan1,2. 1. Department of Medicine 1, University Hospital Frankfurt, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. 2. University Cancer Centre, University Hospital Frankfurt, Goethe-University, 60590 Frankfurt, Germany. 3. Department of Gastroenterology, Hepatology and Diabetology, Internal Medicine II, HELIOS Hospital Emil von Behring, 14165 Berlin, Germany. 4. Department of Medicine II, University Hospital, Ludwig Maximilians University, 81377 Munich, Germany. 5. Department of Interventional Radiology, Klinikum rechts der Isar, Technical University Munich, 80333 Munich, Germany. 6. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, 60590 Frankfurt, Germany. 7. Department of Radiology and Nuclear Medicine, Klinik am Eichert und Helfenstein Klinik, 73312 Göppingen, Germany. 8. Department of General and Viszeral Surgery, University Hospital Frankfurt, Goethe-University, 60590 Frankfurt, Germany. 9. Department of Internal Medicine and Gastroenterology, Helios-Klinikum Berlin-Buch, 13125 Berlin, Germany.
Abstract
BACKGROUND AND AIMS: Systemic treatment with sorafenib has been the standard of care (SOC) in patients with advanced Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) for more than a decade. TACE has been reported to allow better local tumor control in selected patients with BCLC stage C HCC. METHODS: A retrospective analysis of patients with BCLC stage C HCC that were treated with sorafenib and TACE was conducted; they were compared to BCLC stage C patients treated either with TACE or sorafenib in the same period of time outside a clinical trial. RESULTS: A total of 201 patients with BCLC stage C were identified, who were treated with either sorafenib and TACE (group A; n = 54), sorafenib (group B; n = 82) or TACE (group C; n = 65). No significant difference in baseline characteristics was observed. Time to progression was 7.0 months (95% CI: 4.3-9.7), 4.1 months (95% CI: 3.6-4.7) and 5.0 months (95% CI: 2.9-7.1) in groups A, B and C, respectively, and overall survival was 16.5 months (95% CI: 15.0-18.1), 8.4 months (95% CI: 6.0-10.8) and 10.5 months (95% CI: 7.5-13.6), respectively (group A vs. group B: p < 0.001; group A vs. group C: p = 0.0023). Adverse events of grade 3/4 occurred in 34% of patients in group A. CONCLUSIONS: Although sorafenib is a SOC in patients with BCLC stage C HCC, TACE is frequently used as an additional locoregional treatment in selected patients. This combined approach resulted in a significant overall survival benefit in selected patients, although randomized trials have not yet proven this benefit.
BACKGROUND AND AIMS: Systemic treatment with sorafenib has been the standard of care (SOC) in patients with advanced Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) for more than a decade. TACE has been reported to allow better local tumor control in selected patients with BCLC stage C HCC. METHODS: A retrospective analysis of patients with BCLC stage C HCC that were treated with sorafenib and TACE was conducted; they were compared to BCLC stage C patients treated either with TACE or sorafenib in the same period of time outside a clinical trial. RESULTS: A total of 201 patients with BCLC stage C were identified, who were treated with either sorafenib and TACE (group A; n = 54), sorafenib (group B; n = 82) or TACE (group C; n = 65). No significant difference in baseline characteristics was observed. Time to progression was 7.0 months (95% CI: 4.3-9.7), 4.1 months (95% CI: 3.6-4.7) and 5.0 months (95% CI: 2.9-7.1) in groups A, B and C, respectively, and overall survival was 16.5 months (95% CI: 15.0-18.1), 8.4 months (95% CI: 6.0-10.8) and 10.5 months (95% CI: 7.5-13.6), respectively (group A vs. group B: p < 0.001; group A vs. group C: p = 0.0023). Adverse events of grade 3/4 occurred in 34% of patients in group A. CONCLUSIONS: Although sorafenib is a SOC in patients with BCLC stage C HCC, TACE is frequently used as an additional locoregional treatment in selected patients. This combined approach resulted in a significant overall survival benefit in selected patients, although randomized trials have not yet proven this benefit.
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