Sorafenib, A New Treatment for Advanced Hepatocellular Carcinoma: The Preliminary British Columbia Experience

Michael W. H. Suen, Baljinder Salh, Eric M. Yoshida, Alan A. Weiss, Sharlene Gill

ABSTRACT

OBJECTIVE: Hepatocellular carcinoma is the fifth most common cancer worldwide and is a direct consequence of chronic liver disease, most commonly viral hepatitis, and cirrhosis. Current therapies for localized disease include surgical resection, locoregional radiologic interventions such as radiofrequency ablation, transarterial chemoembolization, and in select patients, liver transplantation. Historically, systemic chemotherapy has been disappointing and is rarely offered. Sorafenib is a new oral multikinase inhibitor that in the most recent pivotal clinical trial has demonstrated a survival benefit of almost 3 months over placebo. Sorafenib is now covered by the province via the British Columbia Cancer Agency, and this study aims to assess the preliminary BC experience with this drug.
METHODS: A review was conducted of all patients referred to the British Columbia Cancer Agency with a diagnosis of hepatocellular carcinoma, and we performed a retrospective chart review on 30 patients who had received sorafenib.
RESULTS: Overall median survival was 7 months, similar to the placebo arm of the pivotal trial. Discontinuation of medication because of intolerability and disease progression occurred in 23 patients, and only 30% took 80% of the optimal dose for a median of 2.8 months. Compared to the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial, the BC group consisted of more patients from an Asian descent and more patients with advanced liver disease.
CONCLUSION: These results underscore the significant differences between the perfect conditions of a clinical trial, compared to the “real world” of clinical medicine. Future follow-up review of the BC sorafenib experience is warranted.

KEYWORDS: sorafenib; hepatocellular carcinoma; survival; BCCA; retrospective

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Suen MWH, Salh B, Yoshida EM, Weiss AA, Gill S. Sorafenib, A New Treatment for Advanced Hepatocellular Carcinoma: The Preliminary British Columbia Experience. UBCMJ. 2010 1(2):18-21.