title: Current status of hepatocellular carcinoma treatment in Japan: case study and discussion-voting system.
abstract: The Toward Integrated Treatment of Advanced Hepatocellular Carcinoma with Nexavar (TiTAN) Symposium was held in August 2010 in Tokyo, Japan, during which the position of sorafenib (Nexavar®) in the treatment of HCC in Japan (for which it received approval in 2009) was discussed by a panel of eight expert hepatologists in a session chaired by Dr Kudo. The following article focuses on the discussion that went on during this session, including question and answer sessions regarding the experiences of the 350 conference attendees in treating patients with HCC, as well as some of the more challenging disease management issues. Since 2008, when the phase III Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial demonstrated an increase in the median overall survival (OS) for patients with unresectable HCC treated with sorafenib compared with placebo, international and Japanese guidelines recommend sorafenib as a first-line option for patients with advanced HCC Child-Pugh liver function class A who have extrahepatic metastasis. Sorafenib is also recommended for patients unresponsive to transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC). Importantly, if HCC is judged to be unresponsive to TACE, treatment should be switched to sorafenib in a timely manner. Almost half of the conference attendees said that they used both the Japan Society of Hepatology clinical practice guidelines and the clinical practice guidelines for HCC when determining treatment strategies for individual HCC patients. Sorafenib should currently not be used as adjuvant therapy or in combination with TACE or HAIC until evidence from ongoing clinical trials shows that it is beneficial in these settings.
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, Japan. m-kudo@med.kindai.ac.jp
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.forename: Kenji
authors.initials: K
authors.lastname: Ikeda
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Namiki
authors.initials: N
authors.lastname: Izumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D017410:Practice Guidelines as Topic; D011725:Pyridines / Q000627:therapeutic use*; D000077157:Sorafenib; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib