Regorafenib in patients with advanced Child‐Pugh B hepatocellular carcinoma: A multicentre retrospective study. (9th July 2020)

• Record Type: Journal Article
• Authors: Kim, Hyung‐Don; Bang, Yeonghak; Lee, Myung Ah; Kim, Jin Won; Kim, Jee Hyun; Chon, Hong Jae; Kang, Beodeul; Kang, Myoung Joo; Kim, Ilhwan; Cheon, Jaekyung; Hwang, Jun‐Eul; Kang, Jung Hun; Byeon, Seonggyu; Hong, Jung Yong; Ryoo, Baek‐Yeol; Lim, Ho Yeong; Yoo, Changhoon
• Is Part Of: Liver international. Volume 40:Number 10(2020)
• Page Start: 2544
• Page End: 2552
• Publication Date: 2020-07-09
• Subjects: Child‐Pugh B -- hepatocellular carcinoma -- regorafenib; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14573
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Introduction: Regorafenib is an approved agent in patients with advanced hepatocellular carcinoma (HCC) who progressed on sorafenib, but little is known about its clinical outcomes in Child‐Pugh B patients. We aimed to investigate the safety and effectiveness of regorafenib in Child‐Pugh B HCC patients. Methods: This multicentre retrospective study included 59 patients with Child‐Pugh B HCC who received regorafenib. Comparative analyses were performed with an independent cohort of Child‐Pugh class A patients from the same registry (n = 440). Results: The median age was 58 years (range, 19‐83). All patients had progression on prior sorafenib. Regorafenib was given as 2nd line, and 3rd‐4th line systemic therapy in 37 (62.7%) and 22 (37.3%) patients respectively. Compared to Child‐Pugh A cohort, grade 3‐4 AEs were more common in the Child‐Pugh B cohort (27.1% vs 14.1%, P = .017). The median progression‐free survival (PFS) and overall survival (OS) were 1.8 and 4.6 months, respectively, and these were significantly poorer than the Child‐Pugh A cohort ( P = .008 and P < .001 respectively). Child‐Pugh B patients with albumin‐bilirubin (ALBI) grade 3 had a significantly higher frequency of increased bilirubin ( P = .01 for any grade and P = .01 for grade 3‐4) and showed significantly poorer OS ( P = .021), compared to those with ALBI grade 1 or 2. Conclusion: Regorafenib's poor clinical outcomes and increased frequency of severe adverse events lead us to discourage its use in the Child‐Pugh B population. In particular, regorafenib should not be used in Child‐Pugh B patients with ALBI grade 3.