1. Effectiveness of sorafenib dose modifications on treatment outcome of hepatocellular carcinoma: Analysis in real‐life settings
- Author
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Jeong Won Jang, Sun Hong Yoo, U Im Chang, Hee Yeon Kim, Seung Kew Yoon, Do Seon Song, Sang Wook Choi, Jong Young Choi, Chang Wook Kim, Sung Won Lee, Kwon Yong Tak, Seok Hwan Kim, Pil Soo Sung, Hae Lim Lee, Jung Hyun Kwon, Myeong Jun Song, Jin Mo Yang, and Hee Chul Nam
- Subjects
Adult ,Male ,Sorafenib ,Cancer Research ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,Treatment outcome ,Antineoplastic Agents ,Gastroenterology ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Progression-free survival ,Dosing ,Adverse effect ,neoplasms ,Aged ,Dose Modification ,Aged, 80 and over ,Dose-Response Relationship, Drug ,Drug Tapering ,business.industry ,Cumulative dose ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Survival Analysis ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Female ,business ,medicine.drug - Abstract
Controlling adverse events (AEs) through dose reduction can enhance drug adherence and treatment response. Currently, there is no guide for sorafenib dosing. The aim of this study was to evaluate whether sorafenib dosing could affect treatment outcomes. A total of 782 hepatocellular carcinoma (HCC) patients treated with sorafenib were evaluated for sorafenib dosing and its modifications via medical records at baseline and regular follow-up. Study outcomes included progression-free survival (PFS), overall survival (OS), sorafenib duration, cumulative dose, AEs and drug discontinuation. The median patient survival was 7.7 months. Overall, 242 (30.9%) patients underwent dose reduction and 121 (17.5%) discontinued sorafenib due to AEs. In multivariate analysis, dose reduction was identified to be independently predictive of PFS and OS. The 800-to-400 mg/day group provided significantly better PFS than the 800 mg/day-maintained group or the 800-to-600 mg/day group. Likewise, the 800-to-400 mg/day group resulted in a significantly better OS than other dosing. However, dose reduction to 200 mg/day led to significantly worse PFS and OS. Hand-foot skin reaction and drug discontinuation due to AEs were higher in the 800-to-600 mg/day group than the 800-to-400 mg/day group. The 800-to-400 mg/day group had significantly longer treatment duration and higher cumulative dose than the 800 mg/day-maintained group. Sorafenib dose reduction can improve HCC survival and increase patient tolerance and adherence coupled with longer duration and higher cumulative dose. Dose reduction from 800 to 400 mg/day than to 600 mg/day is recommended when clinically warranted. However, dose reduction to 200 mg/day is not recommendable.
- Published
- 2020