title: Clinical factors related to long-term administration of sorafenib in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Sorafenib has been approved in the indication of unresectable hepatocellular carcinoma, but there are many cases in which administration of the drug is discontinued due to severe side effects. In this study, we compared the characteristics of patients who continued and discontinued sorafenib.
  
  
  METHODS
  Ninety-six patients (75 men and 21 women) were initiated on sorafenib from July 2009 through September 2011. The patient characteristics of interest included gender, age, etiology, Child-Pugh classification, treatment history and frequency, and levels of α-fetoprotein, des- gamma-carboxy prothrombin, aspartate amino acid transferase, and alanine aminotransferase. Duration of administration of sorafenib and reasons for its discontinuation were compared.
  
  
  RESULTS
  Median overall survival was 11.8 months. Discontinuation of sorafenib within 90 days was identified as an independent prognostic factor for overall survival on multivariate analysis (P < 0.0001). Transarterial chemoembolization performed six times or more (P = 0.013) was also identified as an independent factor contributing to discontinuation of sorafenib within 90 days in multivariate analysis. Patients who received sorafenib for ≥90 days had significantly longer overall survival than those who discontinued it (P < 0.0001).
  
  
  CONCLUSIONS
  Prolonged treatment with sorafenib is an important factor in achieving extended overall survival. We recommend starting sorafenib before latent liver damage has occurred as a result of too many transarterial chemoembolization procedures.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nojiri
authors.forename: Atsunori
authors.initials: A
authors.lastname: Kusakabe
authors.forename: Kei
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Noboru
authors.initials: N
authors.lastname: Shinkai
authors.forename: Kentaro
authors.initials: K
authors.lastname: Matsuura
authors.forename: Etsuko
authors.initials: E
authors.lastname: Iio
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Miyaki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nomura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sobue
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
authors.forename: Izumi
authors.initials: I
authors.lastname: Hasegawa
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Ohno
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Etsuro
authors.initials: E
authors.lastname: Orito
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
keywords: discontinuation; efficacy; hepatocellular continuation; sorafenib