title: Sorafenib for the Treatment of Advanced Hepatocellular Cancer - a UK Audit.
abstract: Sorafenib is the current standard treatment for advanced hepatocellular carcinoma. We carried out a national audit of UK patients treated with sorafenib as standard-of-care and those treated with systemic therapy in first-line trials.
  
  
  
  Sorafenib-treated and trial-treated patients were identified via the Cancer Drugs Fund and local databases. Data were collected retrospectively from medical records according to a standard case report form. The primary outcome measure was overall survival, estimated by the Kaplan-Meier method.
  
  
  
  Data were obtained for 448 sorafenib-treated patients from 15 hospitals. The median age was 68 years (range 17-89) and 75% had performance status ≤ 1. At baseline, 77% were Child-Pugh A and 16.1% Child-Pugh B; 38% were albumin-bilirubin grade 1 (ALBI-1) and 48% ALBI-2; 23% were Barcelona Clinic Liver Classification B (BCLC-B) and 72% BCLC-C. The median time on sorafenib was 3.6 months, with a mean daily dose of 590 mg. The median overall survival for 448 evaluable sorafenib-treated patients was 8.5 months. There were significant differences in overall survival comparing Child-Pugh A versus Child-Pugh B (9.5 versus 4.6 months), ALBI-1 versus ALBI-2 (12.9 versus 5.9 months) and BCLC-B versus BCLC-C (13.0 versus 8.3 months). For trial-treated patients (n=109), the median overall survival was 8.1 months and this was not significantly different from the sorafenib-treated patients.
  
  
  
  For Child-Pugh A patients with good performance status, survival outcomes were similar to those reported in global randomised controlled trials. Patients with ALBI grade > 1, Child-Pugh B or poor performance status seem to derive limited benefit from sorafenib treatment.
authors.affiliation: Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: King
authors.affiliation: University of Birmingham, Birmingham, UK; University of Liverpool, Liverpool, UK; Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Palmer
authors.affiliation: University of Birmingham, Birmingham, UK; University of Liverpool, Liverpool, UK; Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: P
authors.initials: P
authors.lastname: Johnson
authors.affiliation: King's College Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Ross
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Hubner
authors.affiliation: The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: K
authors.initials: K
authors.lastname: Sumpter
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Darby
authors.affiliation: University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK.
authors.forename: C
authors.initials: C
authors.lastname: Braconi
authors.affiliation: Leicester Royal Infirmary, Leicester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Iwuji
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Swinson
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: P
authors.initials: P
authors.lastname: Collins
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: K
authors.initials: K
authors.lastname: Patel
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
authors.forename: J
authors.initials: J
authors.lastname: Nobes
authors.affiliation: Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
authors.forename: I
authors.initials: I
authors.lastname: Muazzam
authors.affiliation: Great Western Hospital NHS Trust, Swindon, UK.
authors.forename: C
authors.initials: C
authors.lastname: Blesing
authors.affiliation: Cancer Research UK & UCL Cancer Trials Centre, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kirkwood
authors.affiliation: Cancer Research UK & UCL Cancer Trials Centre, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Nash
authors.affiliation: Department of Oncology, Royal Free London NHS Foundation Trust, London, UK; UCL Cancer Institute, London, UK. Electronic address: t.meyer@ucl.ac.uk.
authors.forename: T
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality; D054869:Clinical Audit; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: ALBI; Child-Pugh; hepatocellular carcinoma; prognosis; sorafenib