Practical effect of sorafenib monotherapy on advanced hepatocellular carcinoma and portal vein tumor thrombosis

Soung Won Jeong, Jae Young Jang, Kwang Yeun Shim, Sae Hwan Lee, Sang Gyune Kim, Sang-Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim, Kyoung Ha Kim, Jung Hoon Kim, Soung Won Jeong, Jae Young Jang, Kwang Yeun Shim, Sae Hwan Lee, Sang Gyune Kim, Sang-Woo Cha, Young Seok Kim, Young Deok Cho, Hong Soo Kim, Boo Sung Kim, Kyoung Ha Kim, Jung Hoon Kim

Abstract

Background/aims: We investigated the effects of sorafenib monotherapy on advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) in a clinical setting.

Methods: In total, 143 consecutive patients with unresectable HCC were treated with sorafenib. Among these patients, 30 patients with advanced HCC and PVTT (Vp3 or 4) were treated with sorafenib monotherapy.

Results: All patients had a performance status of 1 to 2 (Eastern Cooperative Oncology Group 1/2, 20/10) and Child-Pugh class A or B (A/B, 17/13). Eleven patients had modified Union for International Cancer Control stage IVA tumors, whereas 19 had stage IVB tumors. All patients had PVTT (Vp3, 6; Vp4, 24). Following sorafenib monotherapy, three patients (10.0%) had a partial response with PVTT revascularization, and nine (30.0%) had stable disease, with a disease control rate of 33.3%. The median overall survival was 3.1 months (95% confidence interval [CI], 2.70 to 3.50), and the median progression-free survival was 2.0 months (95% CI, 1.96 to 2.05). Fatigue and hand-foot skin reactions were the most troublesome side effects.

Conclusions: A limited proportion of patients with advanced HCC and PVTT exhibited a remarkable outcome after sorafenib monotherapy, although the treatment results in this type of patient is extremely poor. Further studies to predict good responders to personalized therapy are warranted.

Keywords: Carcinoma, hepatocellular; Portal vein; Sorafenib; Thrombosis.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Kaplan-Meier analysis of overall survival and time to progression. (A) The median overall survival was 3.1 months. (B) The median time to progression was 2 months.
Fig. 2
Fig. 2
Decreased hepatocellular carcinoma and portal vein tumor thrombosis (PVTT) revascularization after sorafenib monotherapy. (A, B) Before treatment. (C, D) Four months after sorafenib monotherapy. (A) A 7.0×6.9-cm-sized well-enhanced mass in the hepatic dome. (B) The white line indicates enhanced and expanded PVTT in the main and right portal veins. (C) Markedly decreased size and enhancement of the mass. (D) The white line indicates the markedly decreased size and enhancement of PVTT.

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