Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Hepatol. Jul 27, 2013; 5(7): 364-371
Published online Jul 27, 2013. doi: 10.4254/wjh.v5.i7.364
Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma
Adnan Muhammad, Manish Dhamija, Gitanjali Vidyarthi, Donald Amodeo, William Boyd, Branko Miladinovic, Ambuj Kumar
Adnan Muhammad, Manish Dhamija, Department of Gastroenterology, University of South Florida, Tampa, FL 33620, United States
Gitanjali Vidyarthi, Donald Amodeo, William Boyd, Department of Gastroenterology, James A Haley VA Hospital, Tampa, FL 33612, United States
Branko Miladinovic, Ambuj Kumar, Department of Internal Medicine, Morsani College of Medicine, Center for Evidence Based Medicine, Tampa, FL 33620, United States
Author contributions: Muhammad A and Dhamija M designed and performed the research; Muhammad A and Vidyarthi G wrote the manuscript; Amodeo D and Boyd W edited the manuscript; Miladinovic B and Kumar A did statistical analysis; Kumar A edited the manuscript.
Correspondence to: Adnan Muhammad, MD, Department of Gastroenterology, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33620, United States.
Telephone: +1-813-9742034 Fax: +1-813-9745333
Received: April 15, 2013
Revised: June 2, 2013
Accepted: June 8, 2013
Published online: July 27, 2013
Processing time: 100 Days and 10.8 Hours

AIM: To compare the overall survival (OS) and progression-free survival (PFS) with associated adverse events (AE) in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) + sorafenib vs TACE alone.

METHODS: In this retrospective cohort study we collected data on all consecutive patients with a diagnosis of unresectable HCC between 2007 and 2011 who had been treated with TACE + sorafenib or TACE alone. We hypothesized that the combination therapy is superior to TACE alone in improving the survival in these patients. Data extracted included patient’s demographics, etiology of liver disease, histology of HCC, stage of liver disease with respect to model of end stage liver disease score and Child-Turcotte-Pugh (CTP) classification and Barcelona Clinic Liver Cancer (BCLC) staging for HCC. Computed tomography scan findings, alpha fetoprotein levels, number of treatments and related AE were also recorded and analyzed.

RESULTS: Of the 43 patients who met inclusion criteria, 13 were treated with TACE + sorafenib and 30 with TACE alone. There was no significant difference in median survival: 20.6 mo (95%CI: 13.4-38.4) for the TACE + sorafenib and 18.3 mo (95%CI: 11.8-32.9) for the TACE alone (P = 0.72). There were also no statistically significant differences between groups in OS (HR = 0.82, 95%CI: 0.38-1.77; P = 0.61), PFS (HR = 0.93, 95%CI: 0.45-1.89; P = 0.83), and treatment-related toxicities (P = 0.554). CTP classification and BCLC staging for HCC were statistically significant (P = 0.001, P = 0.04 respectively) in predicting the survival in patients with HCC. The common AE observed were abdominal pain, nausea, vomiting and mild elevation of liver enzymes.

CONCLUSION: Combination therapy with TACE + sorafenib is safe and equally effective as TACE alone in patients with unresectable HCC. CTP classification and BCLC staging were the significant predictors of survival. Future trials with large number of patients are needed to further validate this observation.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, Sorafenib, Survival, Adverse events

Core tip: The incidence of hepatocellular carcinoma (HCC) is increasing and there is a need for better treatment modalities. Transarterial chemoembolization (TACE) and sorafenib are the main course of treatment for unresectable HCC. However there is an emphasis to combine them to improve survival. There is very limited data available to compare the effectiveness of TACE alone vs combination with sorafenib. Our results showed equal efficacy for both treatment arms without compromising adverse events. Child-Turcotte-Pugh classification and Barcelona Clinic Liver Cancer staging were significant predictors of survival. This study is the first reported in the literature comparing the outcome when treated with TACE alone vs TACE + sorafenib in United States patients.