Sunitinib versus sorafenib plus transarterial chemoembolization for inoperable hepatocellular carcinoma patients

Purpose: To compare sunitinib vs sorafenib plus transarterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC) patients. Methods: From January 2010 to December 2016, 104 patients with inoperable stage III HCC were included and randomly divided into two groups. Patients in the sunitinib+TACE (SU+TACE) group received sunitinib orally 37.5 mg daily, while patients in the sorafenib+TACE (SO+TACE) group received sorafenib 400 mg twice daily. The two groups were given sunitinib or sorafenib on an interrupted schedule, with a 4-7 days interval before or after TACE sessions. TACE treatment was repeated every 6-8 weeks. Patients were treated for about 4-6 cycles until the occurrence of toxicity or patient refusal, or progressive disease. Results: The median overall survival (OS) and the median progression-free survival (PFS) in the SO+TACE group were significantly higher than that in the SU+TACE (OS: p=0.017; PFS: p=0.036, respectively). The rates of response and disease control were higher in the SO+TACE group (58%, 79%, respectively) compared to the SU+TACE group (37%, 66%, respectively), although without statistical significance. Regarding the toxicities, we found higher rates of hand-foot skin reaction (HFSR) in the SO+TACE group, while frequent occurrence of thrombocytopenia and neutropenia in the SU+TACE group. Conclusions: The SO+TACE regimen was more effective and well tolerated in patients with unresectable stage III HCC compared to the SU+TACE regimen. The SO+TACE regimen may be a better alternative to the current standard regimens.