title: Sorafenib use in elderly patients with hepatocellular carcinoma: caution about use of platelet aggregation inhibitors.
abstract: OBJECTIVE
  Sorafenib is the standard of care for advanced hepatocellular carcinoma (HCC). The peak incidence of HCC is around 70 years. We aimed to evaluate safety and efficacy of sorafenib in the elderly population.
  
  
  METHODS
  We retrospectively reviewed data from patients treated with sorafenib for HCC at our institution. We compared safety and efficacy data across different age groups.
  
  
  RESULTS
  Since 2005, 129 patients were treated, 78 (60.5 %) were <70 years old and 51 (39.5 %) were ≥70. The frequency of dose reduction was similar between the two groups (48.7 vs. 58.8 %), as was the occurrence of severe toxicities (41.0 vs. 51.0 %) and hospitalization due to toxicity (9.0 vs. 13.7 %). However, asthenia and bleeding were more frequent in the elderly. The higher frequency of bleeding was explained by concomitant antiplatelet treatments, and major asthenia was frequent in PS1 elderly patients. There was a trend toward less frequent interruption of treatment in the younger group (25.6 vs. 39.2 %) and significantly less frequent definitive discontinuation of treatment due to toxicity (24.4 vs. 45.1 %). Median progression-free survival was 5.6 months in both age groups, while median overall survival was 9.6 months in the younger age group and 12.6 months in the older age group.
  
  
  CONCLUSIONS
  Sorafenib showed similar results in terms of safety and efficacy in the elderly and younger HCC populations. Careful baseline evaluation is needed for patient's selection in the elderly population, including discussion about antiplatelet therapy discontinuation and caution in PS1 patients, as well as active management of toxicity.
authors.affiliation: Medical Oncology Department, Centre Eugène Marquis, Av de la bataille Flandres Dunkerque, 35043, Rennes, France, j.edeline@rennes.unicancer.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Edeline
authors.forename: Laurence
authors.initials: L
authors.lastname: Crouzet
authors.forename: Samuel
authors.initials: S
authors.lastname: Le Sourd
authors.forename: Claire
authors.initials: C
authors.lastname: Larible
authors.forename: Angélique
authors.initials: A
authors.lastname: Brunot
authors.forename: Florence
authors.initials: F
authors.lastname: Le Roy
authors.forename: Catherine
authors.initials: C
authors.lastname: Cattenoz
authors.forename: Marianne
authors.initials: M
authors.lastname: Latournerie
authors.forename: Daniel
authors.initials: D
authors.lastname: Gédouin
authors.forename: Anne
authors.initials: A
authors.lastname: Guillygomarc'h
authors.forename: Eveline
authors.initials: E
authors.lastname: Boucher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001247:Asthenia / Q000139:chemically induced / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D015897:Comorbidity; D004347:Drug Interactions; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008099:Liver / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011169:Portal Vein; D012189:Retrospective Studies; D000077157:Sorafenib; D016019:Survival Analysis; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D010975:Platelet Aggregation Inhibitors; D009536:Niacinamide; D000077157:Sorafenib