1. Treatment strategies for advanced hepatocellular carcinoma: Sorafenib vs hepatic arterial infusion chemotherapy
- Author
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Toshihiko Matsumoto, Takuro Hisanaga, Taro Takami, Issei Saeki, Takahiro Yamasaki, Yoshio Marumoto, Yutaka Suehiro, Isao Hidaka, Tsuyoshi Ishikawa, Isao Sakaida, Naoki Yamamoto, Takuya Iwamoto, Masaki Maeda, and Koichi Fujisawa
- Subjects
Oncology ,Sorafenib ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.disease ,digestive system diseases ,Additional research ,law.invention ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Internal medicine ,Hepatic arterial infusion chemotherapy ,medicine ,Treatment strategy ,030211 gastroenterology & hepatology ,Transcatheter arterial chemoembolization ,business ,neoplasms ,medicine.drug - Abstract
Sorafenib is used worldwide as a first-line standard systemic agent for advanced hepatocellular carcinoma (HCC) on the basis of the results of two large-scale Phase III trials. Conversely, hepatic arterial infusion chemotherapy (HAIC) is one of the most recommended treatments in Japan. Although there have been no randomized controlled trials comparing sorafenib with HAIC, several retrospective analyses have shown no significant differences in survival between the two therapies. Outcomes are favorable for HCC patients exhibiting macroscopic vascular invasion when treated with HAIC rather than sorafenib, whereas in HCC patients exhibiting extrahepatic spread or resistance to transcatheter arterial chemoembolization, good outcomes are achieved by treatment with sorafenib rather than HAIC. Additionally, sorafenib is generally used to treat patients with Child-Pugh A, while HAIC is indicated for those with either Child-Pugh A or B. Based on these findings, we reviewed treatment strategies for advanced HCC. We propose that sorafenib might be used as a first-line treatment for advanced HCC patients without macroscopic vascular invasion or Child-Pugh A, while HAIC is recommended for those with macroscopic vascular invasion or Child-Pugh A or B. Additional research is required to determine the best second-line treatment for HAIC non-responders with Child-Pugh B through future clinical trials.
- Published
- 2018