Supplementary Material for: Treatment Stage Migration Maximizes Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib: An Observational Study
Yen C.
Sharma R.
Rimassa L.
Arizumi T.
Bettinger D.
Choo H.Y.
Pressiani T.
Burlone M.E.
Pirisi M.
Giordano L.
Abdulrahman A.
Kudo M.
Thimme R.
Park J.W.
Pinato D.J.
10.6084/m9.figshare.5411002.v1
https://karger.figshare.com/articles/journal_contribution/Supplementary_Material_for_Treatment_Stage_Migration_Maximizes_Survival_Outcomes_in_Patients_with_Hepatocellular_Carcinoma_Treated_with_Sorafenib_An_Observational_Study/5411002
<p><b><i>Background:</i></b> Level I evidence supports the use of
sorafenib in patients with Barcelona Clinic Liver Cancer (BCLC) stage C
hepatocellular carcinoma, where heterogeneity in efficacy exists due to
varying clinicopathologic features of the disease. <b><i>Aim:</i></b> We evaluated whether prior treatment with curative or locoregional therapies influences sorafenib-specific survival. <b><i>Methods:</i></b>
From a prospective data set of 785 consecutive patients from
international specialist centres, 264 patients (34%) were treatment
naïve (TN) and 521 (66%) were pre-treated (PT), most frequently with
transarterial chemoembolization (<i>n</i> = 413; 79%). The primary
endpoint was overall survival (OS) from sorafenib initiation with
prognostic factors tested on uni- and multivariate analyses. <b><i>Results:</i></b>
Median OS for the entire cohort was 9 months; the median sorafenib
duration was 2.8 months, with discontinuation being secondary to
progression (<i>n</i> = 454; 58%) or toxicity (<i>n</i> = 149; 19%). PT patients had significantly longer OS than TN patients (10.5 vs. 6.6 months; <i>p</i> < 0.001). Compared to TN patients, PT patients had a better Child-Pugh (CP) class (CP A: 57 vs. 47%; <i>p</i> < 0.001) and a lower BCLC stage (BCLC A-B, 40 vs. 30%; <i>p</i> = 0.007). PT status preserved an independent prognostic role (<i>p</i>
= 0.002) following adjustment for BCLC stage, α-fetoprotein, CP class,
aetiology, and post-sorafenib treatment status. PT patients were more
likely to receive further anticancer treatment after sorafenib (31 vs.
9%; <i>p</i> < 0.001). <b><i>Conclusion:</i></b> Patients receiving
sorafenib after having failed curative or locoregional therapies survive
longer and are more likely to receive further treatment after
sorafenib. This suggests an incremental benefit to OS from sequential
exposure to multiple lines of therapy, justifying treatment stage
migration in eligible patients.</p>
2017-09-15 08:09:32
Hepatocellular carcinoma
Sorafenib
Treatment stage migration
Prognosis
Treatment-naïve patients