Sorafenib with TACE improves the survival of hepatocellular carcinoma patients with more than 10 cm tumor: a single-center retrospective study

Purpose: Sorafenib, a multikinase inhibitor, is effective in patients with advanced hepatocellular carcinoma (HCC). Transarterial chemoembolization (TACE) is an important palliative treatment for unresectable HCC, but TACE-induced ischemic injury can upregulate angiogenic factors and it might be associated with poor prognosis. The purpose of this study was to evaluate the efficacy of conventional TACE with or without sorafenib in patients with Barcelona Clinic Liver Cancer (BCLC) stage A-B HCC. Methods: Thirty patients with BCLC stage A or B HCC who had undergone TACE were enrolled in this retrospective study. Child-Pugh score, BCLC staging classification, size and number of lesions were recorded. Sorafenib was given 1 month after TACE to some patients who responded to TACE. Repeated TACE was performed on demand. Tumor response was assessed every 12 weeks. The primary objective of this trial was the progression free survival (PFS). Secondary objectives were overall survival (OS), disease control rate (DCR) and total number of TACE interventions. Kaplan-Meier method was used for the estimation of survival and survival curves were compared with Log-rank test. Results: Twenty-five (83.3%) patients had Child-Pugh A and 5 (16.7%) Child-Pugh B, and 24 (80%) patients had BCLC stage B disease and remanining had stage A disease. Lesion size >10 cm was found in 6 patients and 16/7/7 patients had single/two/multiple lesions, respectively. Mean number of TACE was 2.10 +/- 1.369. Seventeen (56.7%) patients used sorafenib after TACE whereas 13 (43.3%) patients were followed without any treatment but received consequent TACEs if needed. PFS of all patients was 10 months (range 3-48); it was 13 months for TACE plus sorafenib group and 9 months for TACE group (p=0.081). In subgroup analysis, TACE plus sorafenib group had better PFS (36 vs 12 months) in patients with tumor size > 10 cm (p=0.025). In the analysis of Child Pugh A cases, PFS of TACE plus sorafenib group was 23 months while it was 10 months in TACE group (p=0.007). Conclusion: Concurrent treatment in Child-Pugh A group HCC with conventional TACE and sorafenib demonstrates a significant efficacy in patients having tumor size >10 cm. In Child-Pugh A group, PFS was superior in the sorafenib plus TACE group than in TACE alone group.