Sorafenib, A New Treatment for Advanced Hepatocellular Carcinoma: The Preliminary British Columbia Experience

Authors

  • Michael W. H. Suen
  • Baljinder Salh Division of Gastroenterology, Vancouver General Hospital and University of British Columbia
  • Eric M. Yoshida Division of Gastroenterology, Vancouver General Hospital and University of British Columbia
  • Alan A Weiss Division of Gastroenterology, Vancouver General Hospital and University of British Columbia
  • Sharlene Gill Division of Medical Oncology, BC Cancer Agency and University of British Columbia

Abstract

Objective: Hepatocellular carcinoma (HCC) is the fifth most common cancer world-wide and is a direct consequence of chronic liver disease, most commonly viral hepatitis, and cirrhosis.  Current therapies for localized disease include surgical resection, locoregional radiologic interventions such as radiofrequency ablation, transarterial chemoemoblization, and in select patients, liver transplantation.  Historically, systemic chemotherapy has been very disappointing and is rarely offered.  Sorafenib is a new oral multi-kinase inhibitor that in the most recent piviotal clincial trial has demonstrated a survival benefit of almost 3 months over placebo.  Sorafenib is now covered by the province via the British Columbia Cancer Agency and this study aims to asses the preliminary BC experience with this drug.

Methods: A review was conducted of all patients referred to the British Columbia Cancer Agency with a diagnosis of hepatocellular carcinoma and we performed retrospective chart review on 30 patients who had received sorafenib.

Results: Overall median survival was 7 months, similar to the placebo arm of the pivotal trial.  Discontinuation of medication because of intolerability and disease progression occurred in 23 patients and only 30% were able to take 80% of the optimal dose for a median of 2.8 months.  Analysis of this group revealed that the BC patients had more advanced liver disease and more were non-European compared to the clinical trial.

Conclusion: These results underscore the significant differences between the perfect conditions of a clinical trial, including selection of patients, compared to the "real world" of clinical medicine.

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Published

2010-07-20

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Section

Academic Research