title: The combination of sorafenib with transarterial chemoembolisation for hepatocellular carcinoma.
abstract: BACKGROUND
  Standard of practice involves using transarterial therapy for multifocal hepatocellular carcinoma (HCC) alone and sorafenib only for more advanced HCC, but the sorafenib and transarterial therapy combination may provide greater efficacy.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of concurrent sorafenib and transarterial therapy in HCC.
  
  
  METHODS
  Consecutive cases of HCC were treated with sorafenib and transarterial therapy, receiving sorafenib 2 to 4weeks before transarterial therapy. Baseline clinical parameters, adverse events (AEs) and survival were collected.
  
  
  RESULTS
  A total of 47 patients received sorafenib and transarterial therapy. The majority of the patients were male (70%) with HCV (60%), median age of 60years, good performance status (0-1), stable cirrhosis (Child: A 72%; B 28%), unresectable tumour (stage: B 81%; C 19%) and median AFP of 24ng/mL. Median follow-up was 12months and median time on sorafenib was 6months. LC Bead TACE was used with a median frequency of 3. The majority of the patients (89%) experienced AEs. The most common AEs were fatigue (51%), hand-foot skin reaction (51%) and diarrhoea (43%). Grade 3 and 4 AEs included fatigue (13%) and hand-foot skin reaction (26%). Most patients required a dose reduction (66%). The main AE related to transarterial therapy was post-TACE syndrome (23%). The disease control rate was 68% at 6months. Overall median survival rate was 18.5months (95% CI 16.1-20.9months).
  
  
  CONCLUSIONS
  Concurrent sorafenib and transarterial therapy is overall safe with no unexpected side effects and encouraging efficacy that warrants further study.
authors: Division of Gastroenterology, Hepatology and Nutrition, Section of Hepatobiliary Diseases, Department of Medicine, University of Florida, Gainesville, FL 32610-0214, USA. cabrer@medicine.ufl.edu
authors: R
authors: R
authors: Cabrera
authors: D S
authors: DS
authors: Pannu
authors: J
authors: J
authors: Caridi
authors: R J
authors: RJ
authors: Firpi
authors: C
authors: C
authors: Soldevila-Pico
authors: G
authors: G
authors: Morelli
authors: V
authors: V
authors: Clark
authors: A
authors: A
authors: Suman
authors: T J
authors: TJ
authors: George
authors: D R
authors: DR
authors: Nelson
references: Mol Cancer Ther. 2008 Oct;7(10):3129-40
references: 18852116
references: Lancet Oncol. 2009 Jan;10(1):25-34
references: 19095497
references: Int J Clin Pract. 2010 Jul;64(8):1034-41
references: 20642705
references: Hepatology. 2006 Jun;43(6):1303-10
references: 16729298
references: Hepatology. 2003 Feb;37(2):429-42
references: 12540794
references: Aliment Pharmacol Ther. 2008 Dec 1;28(11-12):1269-77
references: 18808443
references: CA Cancer J Clin. 2005 Jan-Feb;55(1):10-30
references: 15661684
references: Anticancer Res. 2010 Dec;30(12):5159-64
references: 21187505
references: J Natl Cancer Inst. 2008 May 21;100(10):698-711
references: 18477802
references: Hepatology. 2011 Mar;53(3):1020-2
references: 21374666
references: J Hepatol. 2001 Sep;35(3):421-30
references: 11592607
references: Am J Gastroenterol. 2008 Apr;103(4):914-21
references: 18177453
references: N Engl J Med. 2008 Jul 24;359(4):378-90
references: 18650514
references: Aliment Pharmacol Ther. 2006 Jan 1;23(1):129-35
references: 16393290
references: Gut. 2004 May;53(5):744-9
references: 15082595
references: Aliment Pharmacol Ther. 2010 Feb 15;31(4):461-76
references: 19925500
references: Semin Liver Dis. 2010 Feb;30(1):52-60
references: 20175033
references: Hepatology. 2008 Jun;47(6):1856-62
references: 18506898
references: J Natl Cancer Inst. 2000 Feb 2;92(3):205-16
references: 10655437
references: Gastroenterology. 2007 Jun;132(7):2557-76
references: 17570226
references: Cardiovasc Intervent Radiol. 2010 Feb;33(1):41-52
references: 19908093
references: Hepatology. 2005 Nov;42(5):1208-36
references: 16250051
references: Int J Cancer. 2001 Oct 15;94(2):153-6
references: 11668491
references: Lancet. 2003 Dec 6;362(9399):1907-17
references: 14667750