Prescription Patterns of Sorafenib and Outcomes of Patients with Advanced Hepatocellular Carcinoma: A National Population Study

Background: Sorafenib is the current standard treatment for advanced hepatocellular carcinoma (HCC). We analyzed national prescription patterns and treatment outcomes of patients who received sorafenib for advanced HCC. Patients and Methods: We established a nation-wide cohort of patients who started receiving treatment with sorafenib for advanced HCC between August 2012 and July 2013 from the National Health Insurance Research Database of Taiwan and also retrieved demographic and prescription data. The databases of National Death Registry and Taiwan Cancer Registry were used for survival outcomes and cancer diagnosis information, respectively. Results: A total of 3,293 patients were enrolled. The median overall survival (OS) and time to treatment discontinuation (TTD) of all patients were 6.8 and 2.6 months, respectively. Upon the first prescription of sorafenib, 58.4% of patients received the standard dose (800 mg/day). Among them, 61.9% had subsequent dose reduction. A total of 41.6% of patients initially received lower than standard doses; 36.1% of them had subsequent dose escalation to 800 mg/day. Being male (odds ratio=1.41; p<0.001) and treatment year of 2012 (odds ratio=1.28; p=0.002) were associated with the standard initial dose. Patients who received standard initial dose of sorafenib, compared to patients who received lower initial doses, exhibited longer OS (median of 7.8 vs. 6.6 months, p<0.001) but similar TTD (median of 2.6 vs. 2.9 months, p=0.840). Conclusion: A considerable number of patients with advanced HCC received less than the standard dose of sorafenib. The treatment outcomes in the general population were consistent with those reported in clinical trials.