Modest Survival Benefit With Sorafenib in Advanced HCC Patients
SAN FRANCISCO, CA—Sorafenib was associated with a modest survival benefit in patients with advanced hepatocellular carcinoma (HCC), and to a lesser extent in patients with decompensation, data presented at The Liver Meeting® 2015 presented.
Neehar D. Parikh, MD, MS, from the Division of Gastroenterology, University of Michigan, Ann Arbor, MI, and colleagues examined the outcomes of elderly patients with advanced HCC in the United States to assess survival in patients with sorafenib and predictors of survival. A secondary analysis of continuously enrolled Medicare beneficiaries with HCC diagnoses from 2007–2009 were conducted, based on SEER diagnosis codes.
Study authors compared patients with Stage III/IV HCC who received sorafenib within 6 months of diagnosis to those who received no treatment (control). They calculated the Charlson comorbidity index 12 months before diagnosis and an aggregate variable for decompensated cirrhosis, characterized by presence of esophageal varices or variceal banding, ascites or paracentesis, hepatic encephalopathy or use of neomycin, lactulose or rifaximin). Univariate and multivariate analyses were calculated for predictors of survival.
The results indicated survival was significantly better in the sorafenib treatment group (P<0.001) with a median survival benefit of 88 days. Significant predictors of improved survival in incident HCC were treatment with sorafenib, according to the multivariate analysis (HR 0.66, 95% CI: 0.57–0.78), and being seen at a transplant center (0.76, 95% CI: 0.64–0.91). On the other hand, predictors of worse survival included Stage IV disease (HR 1.41, 95% CI: 1.24–1.59), decompensated cirrhosis (HR 1.43, 95% CI: 1.26–1.63), and being seen at an urban hospital (HR 1.46, 95% CI: 1.19–1.72).
Treatment with sorafenib did not show a survival benefit in a subanalysis of patients with decompensated cirrhosis with a median of 31 days. In addition, presence of ascites and hepatic encephalopathy were associated with worse survival in decompensated patients, while esophageal varices was not.
Dr. Parikh noted that the “treating center, cancer stage, and severity of cirrhosis impact survival in elderly patients and may be useful in deciding who may experience the greatest benefit from sorafenib therapy.”