title: In a 'real-world', clinic-based community setting, sorafenib dose of 400 mg/day is as effective as standard dose of 800 mg/day in patients with advanced hepatocellular carcimona, with better tolerance and similar survival.
abstract: BACKGROUND
  Sorafenib, an oral multityrosine kinase inhibitor, has been approved for treatment of unresectable hepatocellular carcinoma (HCC). British Columbia (BC) was the first province in Canada to provide drug coverage for sorafenib.
  
  
  OBJECTIVE
  To review the BC experience with sorafenib to assess its effectiveness and tolerance in a 'real-world' clinical setting.
  
  
  METHODS
  A retrospective clinic chart review identified 99 patients referred to the BC Cancer Agency from 2008 to 2010 with a diagnosis of HCC who qualified for treatment with sorafenib.
  
  
  RESULTS
  Therapy with sorafenib was initiated and continued at a reduced dosage of 400 mg⁄day in 66 of 99 patients, with 22 patients requiring further dose reduction. Full- and reduced-dose group patients had similar baseline characteristics, except for a higher proportion of female patients (P=0.02) and individuals with alcoholic liver disease (P=0.04) in the full-dose group. The incidence of any grade of adverse effects was higher in the full-dose group (94% versus 77% in the reduced-dose group; P=0.04). Dose reduction rates were significantly higher in the full-dose group, occurring in 66% versus 24% of reduced-dose group patients (P=0.001). The overall survival rates were similar between the two groups: 7.8 months versus 7.1 months in full- versus reduced-dose groups (P=0.14), as were radiological progression rates and alpha-fetoprotein levels.
  
  
  CONCLUSIONS
  In a review of 99 patients in a 'real-world' community setting, a sorafenib dose of 400 mg⁄day was better tolerated and had similar efficacy compared with a sorafenib dose of 800 mg⁄day with respect to survival and outcomes.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Department of Obstetrics and Gynecology, University of British Columbia, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Shingina
authors.forename: Al Moutaz
authors.initials: AM
authors.lastname: Hashim
authors.forename: Mazhar
authors.initials: M
authors.lastname: Haque
authors.forename: Michael
authors.initials: M
authors.lastname: Suen
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
authors.forename: Sharlene
authors.initials: S
authors.lastname: Gill
authors.forename: Fergal
authors.initials: F
authors.lastname: Donnellan
authors.forename: Alan A
authors.initials: AA
authors.lastname: Weiss
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001955:British Columbia; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D000509:alpha-Fetoproteins; D009536:Niacinamide; D000077157:Sorafenib