title: Skin toxicity predicts efficacy to sorafenib in patients with advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  To study the relationship between adverse events (AEs), efficacy, and nursing intervention for sorafenib therapy in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  We enrolled 37 consecutive patients with advanced HCC who received sorafenib therapy. Relationships among baseline characteristics as well as AE occurrence and tumor response, overall survival (OS), and treatment duration were analyzed. The nursing intervention program consisted of education regarding self-monitoring and AEs management, and telephone follow-up was provided once in 1-2 wk.
  
  
  RESULTS
  A total of 37 patients were enrolled in the study, comprising 30 males (81%) with a median age of 71 years. The disease control rate at 3 mo was 41%, and the median OS and treatment duration were 259 and 108 d, respectively. Nursing intervention was given to 24 patients (65%). Every patient exhibited some kinds of AEs, but no patients experienced G4 AEs. Frequently observed AEs > G2 included anorexia (57%), skin toxicity (57%), and fatigue (54%). Factors significantly associated with longer OS in multivariate analysis demonstrated that age ≤ 70 years, presence of > G2 skin toxicity, and absence of > G2 hypoalbuminemia. The disease control rate in patients with > G2 skin toxicity was 13/20 (65%), which was significantly higher compared with that in patients with no or G1 skin toxicity. Multivariate analysis revealed that nursing intervention and > G2 skin toxicity were independent significant predictors for longer treatment duration.
  
  
  CONCLUSIONS
  Skin toxicity was associated with favorable outcomes with sorafenib therapy for advanced HCC. Nursing intervention contributed to better adherence, which may improve the efficacy of sorafenib.
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Shomura
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Tatehiro
authors.initials: T
authors.lastname: Kagawa
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Shiraishi
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Arase
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Koizumi
authors.affiliation: Masako Shomura, Department of Nursing, Tokai University School of Health Sciences, Isehara, Kanagawa 2591193, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mine
keywords: Drug toxicity; Hepatocellular carcinoma; Molecular targeted therapy; Nursing intervention; Surrogate marker