title: Addition of local hepatic therapy to sorafenib in patients with advanced hepatocellular carcinoma (stage BCLC C).
abstract: OBJECTIVE
  For most patients with hepatocellular carcinoma (HCC), diagnosis is invariably done only in the advanced stages of the disease. For advanced, non-metastatic stage, standard therapy is transarterial chemoembolization (TACE). For metastatic disease, the recommended therapy is systemic treatment with sorafenib. In this study, we evaluated the benefit of an additional local hepatic treatment for patients with advanced metastatic disease.
  
  
  METHODS
  In a retrospective study, we assessed the overall survival (OS), time to progression (TTP), and disease control rate (DCR) in 37 patients with metastasized HCC treated with sorafenib. Sixteen patients received additional local therapy, while 21 patients received only sorafenib.
  
  
  RESULTS
  Median OS of patients with combined therapy was significantly higher with 25 months (95% CI: 13.7-36.3 months) as compared to 11 months (95% CI: 6.2-15.8 months) in patients treated with sorafenib alone. TTP was 7 months (95% CI: 5.3-8.7 months) compared to 5 months (95% CI: 3-7 months) and DCR was 87 versus 72% after 3 months and 31 versus 22% after 9 months.
  
  
  CONCLUSIONS
  These data suggest that control of the liver tumor burden by local therapy in combination with sorafenib might prove beneficial for metastasized HCC. Randomised studies are needed to confirm this exploratory finding.
authors.affiliation: Department of Internal Medicine II, University Hospital Munich, Campus Großhadern, Munich, Germany.
authors.forename: Laura
authors.initials: L
authors.lastname: Schmidt
authors.forename: Mark
authors.initials: M
authors.lastname: op den Winkel
authors.forename: Katharina
authors.initials: K
authors.lastname: Fischer
authors.forename: Gundula
authors.initials: G
authors.lastname: Straub
authors.forename: Barbara
authors.initials: B
authors.lastname: Rauch
authors.forename: Philpp Marius
authors.initials: PM
authors.lastname: Paprottka
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
authors.forename: Frank Thomas
authors.initials: FT
authors.lastname: Kolligs
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D015251:Epirubicin / Q000627:therapeutic use*; D004998:Ethiodized Oil / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D015251:Epirubicin; D004998:Ethiodized Oil; D000077157:Sorafenib