Analysis of efficacy of single agent sorafenib in advanced HCC patients

Abstract

Liver cancer is estimated to haveranked4thand 2nd, respectively, in terms of cancer incidence and mortality worldwide in 2012. Its uneven distribution is due to a range of factors including race, sex, age, viral hepatitis, dietary aflatoxin, and diet. The traditional treatments for liver cancer are surgical treatment and systemic treatment. Patients with good liver function usually undergo liver resection, the optimal option for HCC (hepatocellular carcinoma) patients at early tumor stage. Liver transplantation also has great efficacy and recurrence-free rate. Given the scarcity of donor resources, it is critical to select patients with good potential for achievement of clinical benefit. In fact, only a small portion of patients can benefit from surgical treatment due to poor liver function and prognosis. Other treatments such as TACE, PEI, and RFA help to palliate tumor progression. Systemic therapy is suitable for patients at advanced tumor stage. Various molecular agents targeting different signaling pathways are arranged for patients with different health conditions. In recent years, immunotherapy has also produced encouraging results. 504 HCC patients at Queen Mary Hospital in Hong Kong were treated with single agent sorafenib from 2008 to 2013. I’m going to verify the efficacy and safety of this drug for Hong Kong population. Demographic and clinical data of 493 patients in total were collected for analysis, including etiology, initial diagnosis, prior treatment, sites of disease, baseline assessments, AFP(alpha-fetoprotein), side effects, treatment and follow up. Excel and SPSS were used for general and statistical analysis, summarizing the basic assessments for patients and exploring potential relationships between different factors through a cox proportional hazard model. In terms of efficacy, treatment with sorafenib alone produced good results (20% partial response). To date, sorafenib is the only standard systemic treatment for HCC patients since the SHARP trial in 2008. However, many patients have been found to develop resistance to this drug and the mechanism is still under investigation. It is therefore essential to explore alternative molecular targeted agents for use in these sorafenib-refractory patients. Encouraging evidence has been found for efficacy and safety of several novel agents including brivanib, sunitinib, bevacizumab, lenalidomide, regorafenib in the treatment of advanced HCC patients. Improved understanding of signaling pathways and vascular abnormality will also help to develop specific targeted therapies. Researchers all over the world are making their effort to explore more agents for clinical trials, which might bring a bright future for HCC patients.