Hepatic arterial infusion chemotherapy after sorafenib treatment in patients with advanced hepatocellular carcinoma who are unfit for regorafenib.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 355-355
Author(s):  
Takeshi Terashima ◽  
Tatsuya Yamashita ◽  
Noboru Takata ◽  
Kuniaki Arai ◽  
Eishiro Mizukoshi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Hepatic Arterial Infusion ◽  
Hepatic Arterial Infusion Chemotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Arterial Infusion ◽  
Sorafenib Treatment ◽  
Arterial Infusion Chemotherapy ◽  
Infusion Chemotherapy

355 Background: The RESORCE trial proved survival benefit of regorafenib on advanced hepatocellular carcinoma (aHCC) in the limiting cohort. This study aimed to investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) as second-line treatment in patients with aHCC who are unfit for regorafenib. Methods: We studied consecutive 159 patients with aHCC treated with sorafenib in our institution from June 2009 to March 2018. We divided them into two groups according to the eligibility for RESORCE trial (Rego or non-Rego group) and investigated the efficacy of HAIC as post-sorafenib treatment. Moreover, we also analyzed the prognostic factors in each group. Results: When sorafenib treatment failed, 63 patients (39.6%) fulfilled key inclusion criteria of the RESORCE trial and were considered as fit for regorafenib treatment (Rego group). Among 96 remaining patients (non-Rego group), 34 patients (35.4%) were treated with HAIC after sorafenib. The objective response and the median progression-free survival of HAIC were 38.2% and 3.9 months, which were independent of the efficacy or treatment duration of sorafenib. The median survival of HAIC after sorafenib was 11.3 months which was significantly longer than that of 62 patients without HAIC (4.7 months; P = 0.023). Four factors, HAIC (HR 0.516), Child-Pugh A (HR 0.362), tumor size ≥35mm (HR 1.959), and AFP ≥200 (HR 1.728), were identified as independent prognostic factors after sorafenib in multivariate analysis. In Rego group, 14 patients were actually treated with regorafenib and their survival after sorafenib was longer than that of the patients without regorafenib and with HAIC (P < 0.01 and P < 0.01, respectively). In Rego group, regorafenib (HR 0.152), extrahepatic lesions (HR 2.160), and ≥10 intra-hepatic lesions (HR 2.099) were identified as prognostic factors after sorafenib in multivariate analysis. Conclusions: HAIC showed promising tumor response and patients’ outcome for the patients who are unfit for regorafenib. Further investigation is needed to compare HAIC with ramucirumab, cabozantinib or nivolumab.

scholarly journals Survival Benefit of Hepatic Arterial Infusion Chemotherapy over Sorafenib in the Treatment of Locally Progressed Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 646
Author(s):  
Hideki Iwamoto ◽  
Takashi Niizeki ◽  
Hiroaki Nagamatsu ◽  
Kazuomi Ueshima ◽  
Takako Nomura ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Factors ◽  
Initial Treatment ◽  
Local Treatment ◽  
Hepatic Arterial Infusion ◽  
Hepatic Arterial Infusion Chemotherapy ◽  
Arterial Infusion ◽  
Sorafenib Treatment ◽  
Arterial Infusion Chemotherapy ◽  
Infusion Chemotherapy

BACKROUND: Not all patients with hepatocellular carcinoma (HCC) benefit from treatment with molecular targeted agents such as sorafenib. We investigated whether New-FP (fine-powder cisplatin and 5-fluorouracil), a hepatic arterial infusion chemotherapy regimen, is more favorable than sorafenib as an initial treatment for locally progressed HCC. METHODS: To avoid selection bias, we corrected the data from different facilities that did or did not perform New-FP therapy. In total, 1709 consecutive patients with HCC initially treated with New-FP or sorafenib; 1624 (New-FP, n = 644; sorafenib n = 980) were assessed. After propensity score matching (PSM), overall survival (OS) and prognostic factors were assessed (n = 344 each). Additionally, the patients were categorized into four groups: cohort-1 [(without macrovascular invasion (MVI) and extrahepatic spread (EHS)], cohort-2 (with MVI), cohort-3 (with EHS), and cohort-4 (with MVI and EHS) to clarify the efficacy of each treatment. RESULTS: New-FP prolonged OS than sorafenib after PSM (New-FP, 12 months; sorafenib, 7.9 months; p < 0.001). Sorafenib treatment, and severe MVI and EHS were poor prognostic factors. In the subgroup analyses, the OS was significantly longer the New-FP group in cohort-2. CONCLUSIONS: Local treatment using New-FP is a potentially superior initial treatment compared with sorafenib as a multidisciplinary treatment in locally progressed HCC without EHS.

scholarly journals Clinical Benefits of Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma

2021 ◽  
Vol 11 (4) ◽  
pp. 1882
Author(s):  
Takahiro Yamasaki ◽  
Issei Saeki ◽  
Yurika Kotoh-Yamauchi ◽  
Ryo Sasaki ◽  
Norikazu Tanabe ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Vascular Invasion ◽  
Hepatic Arterial Infusion ◽  
Hepatic Arterial Infusion Chemotherapy ◽  
Advanced Hepatocellular Carcinoma ◽  
Arterial Infusion ◽  
Arterial Infusion Chemotherapy ◽  
Infusion Chemotherapy ◽  
Recent Success ◽  
Clinical Benefits

Recent success of systemic therapeutic agents, including combination immunotherapy, could promote a change in the treatment strategy in patients with advanced hepatocellular carcinoma (HCC). Although hepatic arterial infusion chemotherapy (HAIC) is a treatment option for advanced HCC in Japan, it is not recommended by other guidelines. We discuss the clinical benefits of HAIC compared to sorafenib. The clinical benefits of HAIC are as follows: (1) even a patient with Child–Pugh B HCC (7 or 8 points) is a candidate for HAIC (2) Child–Pugh scores barely decline with the use of HAIC compared with sorafenib (3) HAIC is highly effective in patients with vascular invasion compared with sorafenib; and (4) survival in patients receiving HAIC may not be associated with skeletal muscle volume. In contrast, the disadvantages are problems related with the reservoir system. HAIC has clinical benefits in a subpopulation of patients without extrahepatic metastasis with Child–Pugh A HCC and vascular invasion (especially primary branch invasion or main portal vein invasion) or with Child–Pugh B HCC.

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