Page 251 - ebook HCC

EASL HCC SUMMITHCC SUMMIT
GENEV
PROGRAMME
248
248 PROGRAMME AND ABSTRACTSAND ABSTRACTS GENEVA, SWITZERLANDA, SWITZERLAND EASL 249
249
FEBRUARY 13 - 16, 2014Y 13 - 16, 2014
FEBRUAR
Poster Board Number C33 Poster Board Number C34
CORRELATION BETWEEN LDH LEVELS AND IDENTIFICATION OF RESPONDERS TO
RESPONSE TO SORAFENIB IN HCC PATIENTS SORAFENIB IN HEPATOCELLULAR CARCINOMA:
IS TUMOUR VOLUME MEASUREMENT THE WAY
FORWARD?
Rodolfo Sacco , Lorenzo Fornaro , Caterina Vivaldi , Chiara Caparello ,
2
2
1
2
Gianna Musettini , Gianluca Masi , Valeria Mismas , Barbara Ginanni ,
3
2
2
1
Antonio Romano , Giampaolo Bresci and ITA.LI.CA. Group
1
1
2
1
2
3
2
1
1 Gastroenterology, Oncology, Radiology, Pisa University Hospital, Pisa, Italy Rodolfo Sacco , Irene Bargellini , Alessandra Scionti , Valeria Mismas ,
Chiara Caparello , Caterina Vivaldi , Gianluca Masi , Giampaolo Bresci ,
3
3
3
1
Corresponding author’s e-mail: saccorodolfo@hotmail.com Carlo Bartolozzi and ITA.LI.CA Group
2
3
1 Gastroenterology, Radiology, Oncology, Pisa University Hospital, Pisa, Italy
2
Introduction: Lactate dehydrogenase (LDH) is a predictor of clinical outcome in Corresponding author’s e-mail: saccorodolfo@hotmail.com
hepatocellular carcinoma (HCC) patients. However, the predictive role of LDH on the
clinical outcomes of sorafenib treatment has been poorly documented.
Introduction: Early assessment of hepatocellular carcinoma (HCC) response during
Aims: The correlation between LDH levels and clinical outcomes in HCC patients treated sorafenib (SO) treatment is challenging, since tumour necrosis can be inhomogeneous as
with sorafenib included in the Nation-wide Italian database ITA.LI.CA. is investigated here. far as extension and radiological appearance.
Methodology: The ITA.LI.CA. database contains data of 5136 HCC patients treated at
18 Italian Centers. All patients treated with sorafenib treatment and with available LDH Aims: We retrospectively evaluated prognostic value of different imaging criteria, such
values were considered. A ROC analysis was performed to find a suitable threshold for as RECIST (Response Evaluation Criteria in Solid Tumours) 1.1, EASL (European
baseline LDH levels. Overall Survival (OS) and time to progression (TTP) were compared Association for the Study or The LIver), modifìed RECIST (mRECIST), tumour density
in patients with LDH above and below the identified threshold. Study endpoints were also and volume variations, in the early follow-up of SO treatment.
evaluated according to different patterns of LDH levels during treatment.
Methodology: The stucly inclucled 22 patients (18 male. mean age 68 years). Two
Results: Baseline LDH levels were available for 97 patients (85 males, 61 in BCLC-C independent radiologists reviewed baseline and 2months follow-up computed tomography
stage); data on LDH levels during sorafenib were reported for 10 patients. Mean (CT) images to assess response according to RECIST 1.1, mRECIST, EASL. Choi’s
CLINICAL POSTER ABSTRACTS ≥297 U/L (n=47) and in those with lower LDH concentrations (n=52) (OS: 12.0 months in Results: Response criteria and volume measurements were reproducible (k> 0.80). The CLINICAL POSTER ABSTRACTS
baseline LDH concentration was 324±141 U/L.The most accurate cut-off value for LDH
criteria (decreased tumour density ≥15%) ancl arterial-enhancing tumour volume ratio.
concentration was 297 U/L. Both study endpoints were equal in patients with LDH values
Alfa-fetoprotein (AFP) variations were expressed as AFP ratio.
each population; TTP: 4.0 months in each group).During treatment, LDH values decreased
overall disease control rate was 40.9% by EASL and mRECIST and 27.3% by RECIST
in three patients (mean difference=-219 U/L). Patients with decreased LDH concentrations
1.1; a ≥15% decrease in tumour density was observed in 9 patients (40.9%). Mean volume
have a prolonged OS versus those with unmodified/increased values (p=0.0083; all
patients with decreasing LDH arealive, median OS for patients with increasing LDH was
8.0 months). Median TTP was 19.0 months in patients with decreasing LDH and 3.0
65.9%. Volume ratio resulted to be the only prognostic factor for survival, with 1-year
monthsin those with increasing values (p=0.008). ratio was 1.73 ± 2.12; mean AFP ratio was 14 ± 37. One-year overall survival rate was
cumulative survival rates of 90% for volume ratio 1.1 and 45.4% for volume ratio > 1.1
(P=0.04)
Conclusions: The clinical benefits of sorafenib do not seem influenced by baseline LDH.
However, a decreased LDH concentration during sorafenib might be associated with Conclusions: Tumour volume measurements are reproducible and should be considered
improved clinical outcomes. as an alternative to RECIST, mRECIST and/or EASL since they may provide an early
prognostic marker of response in HCC patients treated with SO.