title: Effect of treatment with branched-chain amino acids during sorafenib therapy for unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  To examine the effect of branched-chain amino acid (BCAA) therapy for patients with unresectable hepatocellular carcinoma (HCC) treated with sorafenib.
  
  
  METHODS
  Seventy-eight subjects with unresectable HCC with a serum level of albumin of 3.5 g/dL or less treated with sorafenib were evaluated. They were classified into two groups: those receiving BCAA granules (n = 34; BCAA group) or a regular diet (n = 44; control group). We compared overall survival and administration period of sorafenib, and analyzed absolute changes in serum levels of albumin during sorafenib therapy in 41 patients who continued sorafenib therapy for 1 month or more with a follow up of more than 3 months.
  
  
  RESULTS
  Median survival time (MST) in BCAA and control groups was 350 and 143 days (P = 0.007), respectively. Median administration period of sorafenib in the two groups was 59 and 41 days (P = 0.018). In the 41 patients described above, at 1 month, there was no significant change in the serum level of albumin between the two groups, but at 3 months, the difference in the absolute change in the serum level of albumin in the two groups reached significance (P = 0.023). In these subgroup analyses, the administration period of sorafenib as well as the MST in the BCAA group were significantly longer than those in the control group (P = 0.020 and = 0.004).
  
  
  CONCLUSIONS
  BCAA treatment during sorafenib therapy in HCC patients is useful for maintaining hepatic functional reserve, which may help to avoid early discontinuance of sorafenib therapy and improve survival.
authors.affiliation: Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Takeda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Eriko
authors.initials: E
authors.lastname: Iguchi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ohara
authors.forename: Azusa
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Sumio
authors.initials: S
authors.lastname: Saito
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishijima
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nasu
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Komekado
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kita
authors.forename: Toru
authors.initials: T
authors.lastname: Kimura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Osaki
keywords: albumin; branched-chain amino acid; hepatocellular carcinoma; liver dysfunction; sorafenib