title: Combination of TACE and Sorafenib Improves Outcomes in BCLC Stages B/C of Hepatocellular Carcinoma: A Single Centre Experience.
abstract: Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of combination of TACE and sorafenib in BCLC stages B/C.
  
  
  
  We undertook an observational study on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival.
  
  
  
  Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLCC. Baseline characteristics were comparable. The predominant etiology was cryptogenic (37.2% and 38.5%, p = NS). 49.1% in BCLC-B and 56.9% in BCLC-C had received TACE+sorafenib. In BCLC-B, the overall survival improved from 9 months (95% CI 6.3-11.7) using TACE only to 16 months (95% CI 12.9-19.1) using TACE+sorafenib (p &lt; 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4 months (95%CI 3-5) to 9 months (95%CI 6.8-11.2) (p &lt; 0.0001). As per mRECIST criteria, patients on TACE+sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (p &lt; 0.0001) in BCLC-C but not in BCLC-B group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted.
  
  
  
  TACE+sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients.
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Joy
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Chandan
authors.initials: C
authors.lastname: Kedarisetty
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Venkataraman
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Srinivasan
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Thiruchunapalli
authors.initials: T
authors.lastname: Deepashree
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Mangerira
authors.initials: M
authors.lastname: Uthappa
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Kaliamurthy
authors.initials: K
authors.lastname: Ilankumaran
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Govil
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Mettu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib
keywords: Chronic liver disease; Fibrosis; Liver Transplant; hepatoma; palliation