Overall survival of patients with HCC treated with sorafenib versus patients treated with supportive therapy in evidence in Oncology Cabinet of Municipal Hospital of Pascani in session 2013-2018
Authors: E. Bosteanu, V. Hincu
Journal: Annals of Oncology (2018)

Introduction: Sorafenib is a standard systemic therapy in patients with advanced HCC and well preserved hepatic function (stage C BCLC)and the patients with HCC in intermediate stage who showing progression after TACE. In the case of the progression of the disease or the intolerance to sorafenib is preferred the administration of the BSC. In the patients with terminal disease and with sever diminished function and a poor performance status is recommended just BSC because the survival of these patients is 6 months maximum. Methods: The study group was created from the patients with HCC who were treated with systemic therapy with sorafenib in Oncology Cabinet of Municipal Hospital Pascani in session 2013-2018 and from the patients with HCC which benefited only from supportive therapy. Because overall survival of the patients with advanced HCC not exceeding 2 years, we considered particularly desirable pursuit of the patients with HCC from the point of view of overall survival. Another aim of the paper was the incidence of side effects on the long term and progression free survival. They evaluated 44 patients with advanced HCC from witch 15 patients (34%) was treated with sorafenib, while 44 patients (100%) was treated with BSC (best supportive care). Of the 44 patients, 35 patients (79,6%) are males, 3 patients (7%) are age less than 50 years old. Of all patients with advanced HCC, 4 patients (9%) had a good performance status (ECOG 0-1), the other 91% from the patients had a poor performance status (ECOG 2-3). Of all patients treated with sorafenib, 12 patients (27%) had a history of viral B hepatitis, 11 patients (25%) had a history of viral C hepatitis, 14 patients (32%) had toxic hepatitis, 8 patients had a multicentric HCC (18%), 2 patients (5%) presented brain metastases, 5 patients (11%) had pulmonary metastases, 4 patients (9%) had bone metastases, 9 patients (20%) had hepatic metastases, 3 patients (7%) had lymph node metastases. Regarding the number of platelets, 17 patients (39%) had a thrombocytopenia grade II-III, with bleeding (melena and epistaxis). The patients with poor performance status who was been treated with BSC had an unfavorable evolution of the disease. Results: Of all patients, 12 patients (27%) had an overall survival less than 3 months, 12 patients (27%) had three-month survival, 6 patients (14%) had overall survival less than 6 months, 12 patients (27%) had overall survival more than 6 months, 5 patients (11%) had overall survival more than 1 year and 1 patient (2%) had overall survival of 3,5 years. Of all 44 patients, 20 patients had a good evolution with a good survival. Regarding side effects of sorafenib a number of 9 patients (20%) presented palmar-plantar erythrodysesthesia, which was submitted with dose reduction (800 mg to 400 mg/day). Twelve patients (27%) presented with major asthenia with a favorable evolution. Three patients (7%) presented minor bleeding remitted under hemostatic therapy. Patients with HCC grafted on liver cirrhosis had an unfavorable evolution, reducing overall survival. Conclusion: Patients treated with Sorafenib had a higher survival than those treated with BSC, with the condition that this treatment had been introduced at the early stages of the disease (Child Pugh A or B), without thrombocytopenia, with unique liver lesions and no history of liver cirrhosis.