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Systemic Cytotoxic Chemotherapy of Patients With Advanced Hepatocellular Carcinoma in the Era of Sorafenib Nonavailability

Yoon, Eileen L. MD; Yeon, Jong Eun MD, PhD; Lee, Hyun Jung MD; Suh, Sang Jun MD; Lee, Sun Jae MD; Kang, Seong Hee MD; Kang, Keunhee MD; Yoo, Yang Jae MD; Kim, Ji Hoon MD, PhD; Yim, Hyung Joon MD, PhD; Byun, Kwan Soo MD, PhD

Journal of Clinical Gastroenterology: March 2014 - Volume 48 - Issue 3 - p e22–e29
doi: 10.1097/MCG.0b013e3182a54ec8
ONLINE ARTICLE: Original Article

Goals: The goal of the study was to compare the efficacy and safety of sorafenib with those of systemic cytotoxic chemotherapy.

Background: Sorafenib treatment has shown to improve the survival in patients with advanced hepatocellular carcinoma (HCC) when compared with placebo. However, whether sorafenib controls advanced-stage HCC better than systemic cytotoxic chemotherapy has not been elucidated.

Study: We retrospectively reviewed the medical records of 220 patients with measurable advanced HCC who had not received systemic treatment previously between January 2007 and April 2012. Among these patients, 78 had been treated with sorafenib. Another 14 patients who were treated with a 4-weekly regimen of adriamycin, cisplatin, and capecitabine were included as the historical control group for comparison. The median overall survival, the progression-free survival, response rates, and safety profiles were evaluated.

Results: Baseline characteristics were similar between the treatment groups. The median overall survival was 7.2 months [95% confidence interval (CI), 5.6-8.8] in the sorafenib group and 11.2 months (95% CI, 8.1-14.2) in the cytotoxic chemotherapy group (P=0.10). The median progression-free survival was 3.2 months (95% CI, 2.2-4.3) in the sorafenib group and 5.9 months (95% CI, 3.6-8.2) in the cytotoxic chemotherapy group (P=0.07). The deterioration of liver function and neutropenia were the most frequent serious adverse events in the sorafenib and the systemic chemotherapy group.

Conclusions: Although a direct head-to-head comparison could not be done, there were some patients who showed a good response to systemic cytotoxic chemotherapy. Further assessment is necessary to study the role of chemotherapy in patients who are intolerant or intractable to sorafenib.

Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, Korea

Supported by a grant from Korea University.

The authors declare that they have nothing to disclose.

Reprints: Jong Eun Yeon, MD, PhD, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea (e-mail:

Received January 23, 2013

Accepted July 14, 2013

© 2014 by Lippincott Williams & Wilkins