Sorafenib treatment of patients with intermediate and advanced hepatocellular carcinoma-institutional experience

Introduction: Hepatocellular carcinoma is the third leading cause of cancer related death globally with gradually growing incidence. In more than 80% of the cases it develops in cirrhotic liver. During the course of the treatment we have to take in account the stage of the underlying liver disease. In 60–70% of the patients hepatocellular carcinoma is diagnosed at intermediate or advanced stage, when the prognosis of the disease is poor because of the lack of effective treating options. Sorafenib is a new drug for the systemic treatment of hepatocellular carcinoma; it inhibits tumor cell proliferation and angiogenesis. As proven by a phase 3 trial, it prolongs the median survival of patients with advanced hepatocellular carcinoma by nearly three months.

Methods: From August 2008, twenty-seven patients with intermediate or advanced hepatocellular carcinoma received sorafenib treatment in our hospital. We examined the time to radiological progression and the side effect profile by physical examination, laboratory tests and CT-scans.

Results: Diarrhea and weight loss proved to be the most frequent side effects. Furthermore, with less frequency, we experienced hand-foot-skin reaction, nausea, fatigue, hoarseness and hair loss. We had to disrupt treatment because of hand-foot-skin reaction, toxicoderma and decompensation of liver cirrhosis. Diarrhea warranted dose reduction. We didn't experience serious hematological toxicity or hypertension. We are also going to present the results of the CT-scans performed every two months.

Conclusions: During the treatment of patients with hepatocellular carcinoma the stage of hepatic cirrhosis influences the available treatment options. Sorafenib, although it has many side effects, can safely be used in patients with intermediate or advanced hepatocellular carcinoma with good hepatic functions in order to prolong survival.