Tolerance and outcomes of sorafenib in elderly patients treated for advanced hepatocellular carcinoma. Issue 9 (September 2017)

• Record Type: Journal Article
• Authors: Williet, Nicolas; Clavel, Léa; Bourmaud, Aurélie; Verot, Céline; Bouarioua, Nadia; Roblin, Xavier; Merle, Philippe; Phelip, Jean-Marc
• Is Part Of: Digestive and liver disease. Volume 49:Issue 9(2017)
• Page Start: 1043
• Page End: 1049
• Publication Date: 2017-09
• Subjects: Elderly -- Hepatocellular carcinoma -- Safety -- Sorafenib; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2017.06.008
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Introduction: Use of sorafenib remains debated in elderly patients treated for advanced hepatocellular carcinoma (HCC). Methods: This was a bicentric retrospective study including all patients ≥75 years and treated with sorafenib for advanced HCC between January 2010 and March 2014. Results: Of the 51 patients included (median age: 78 years, range: 75–92; performance status (PS) 0–1: 98%; cirrhosis: 88.2%; Child–Pugh A: 95.6%) all experienced at least one adverse event (AE). About 2/3 of them (66.7%) had grade 3–4 toxicities, including fatigue (43.1%), hand foot skin syndrome (11.8%), anorexia (9.8%) or diarrhea (9.8%). After adjustment for arterial hypertension, heart failure, other(s) cardiovascular history(ies), and sorafenib dose at baseline, only patients ≥80 years were associated with severe AE (OR: 13.3; p = 0.009). Discontinuation for toxicity was reported in 31 (60.8%) patients, mainly within the 3rd months, especially in those who had PS ≥1 at baseline (OR: 10.4; p = 0.01), or other cardiovascular histories (OR: 30.9; p = 0.016). In this setting, overall survival was significantly reduced (HR: 4.5; p < 0.0001). Conclusion: Tolerance of Sorafenib seems to be low in elderly, especially for patients aged ≥80 years or with PS ≥1. Starting with reduced dose of sorafenib does not seem to impact results. Some of these patients may truly benefit from the treatment in terms of survival.