title: Sorafenib and hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombus.
abstract: BACKGROUND
  Patients with advanced hepatocellular carcinoma (aHCC) and portal vein tumor thrombus (PVTT) still have a very poor prognosis, even though the oral multikinase inhibitor sorafenib has revolutionized treatment of aHCC in patients with liver cirrhosis (LC). Standardization of multimodal therapy for aHCC with PVTT has not yet been achieved.
  
  
  OBJECTIVE
  This retrospective study was performed to clarify the usefulness of combined treatment with sorafenib and hepatic arterial infusion chemotherapy (HAIC) for patients with LC, aHCC and PVTT.
  
  
  METHODS
  Twenty adult Japanese patients with LC underwent HAIC (HAIC group) between 2002 and 2009, while 18 patients received HAIC after treatment with sorafenib between 2009 and 2014 (SF-HAIC group).
  
  
  RESULTS
  Among patients with Child-Pugh class A disease, the median survival time of the SF-HAIC group (315 days) was significantly longer than that of the HAIC group (197 days), while there was no significant difference between the two groups (234 and 228 days) among patients with Child-Pugh class B disease. HAIC led to a partial response (PR) in 16.7% of patients with class A disease and 21.4% of patients with class B disease. With SF-HAIC, PR was obtained in 63.8% and 42.9% of patients respectively, although the PR rate was only 9.1% and 0.0%, respectively, after treatment with sorafenib alone for four weeks.
  
  
  CONCLUSIONS
  When multimodal therapy is employed for patients with LC in Child-Pugh class A disease with aHCC and PVTT, performing HAIC after four weeks of sorafenib treatment might improve both the tumor response and patient survival.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan hidenari@aol.com.
authors: Hidenari
authors: H
authors: Nagai
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Takanori
authors: T
authors: Mukozu
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Y U
authors: YU
authors: Ogino
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Daigo
authors: D
authors: Matsui
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Teppei
authors: T
authors: Matsui
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Noritaka
authors: N
authors: Wakui
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Koichi
authors: K
authors: Momiyama
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Yoshinori
authors: Y
authors: Igarashi
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine Omori School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan.
authors: Yasukiyo
authors: Y
authors: Sumino
authors: Department of Medical Biochemistry, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan.
authors: Koji
authors: K
authors: Higai
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D000077157:Sorafenib; D013927:Thrombosis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: HCC; hepatic arterial infusion chemotherapy; liver cirrhosis; sorafenib