Page 38 - 台灣肝癌醫學冬季會手冊-1222-V3_Neat

Sorafenib in Advanced Hepatocellular Carcinoma

The therapeutic experience in Taitung MacKay Memorial Hospital

Despite being one of the leading causes of cancer death globally, hepatocellular carcinoma (HCC) has

historically not been the focus of novel drug development. Over the past several years, the results from a
number of hallmark phase 3 studies draw attentions towards the treatment of advanced HCC. Today, the
treatment landscape for advanced HCC has recently changed and become relatively effective. In HCC,
immune‐oncology approaches have garnered much attention; there is still a need to better understand criteria

for patient selection and to optimize combination strategies and maximize the potential of these approaches.
Although many types of systemic therapies were available, we aimed to perform a hospital-based,
retrospective analysis comparing the effect of Nexavar therapy between patients with BCLC (Barcelona
Clinic Liver Cancer Classification) stage B (intermediate) and those of BCLC stage C (advanced) at Taitung

Mackay Memorial Hospital in Taiwan.

A retrospective study of medical record and laboratory data was conducted for Nexavar therapy among
patients with advanced HCC from Oct 2010 to Aug 2020. A total of 115 patients received Nexavar therapy

during the study period. Exclusion criteria included patients who were lost to follow-up and those who were
still alive. The remaining 99 patients were included in the final analysis. Most patients were predominately
male (70.7%), older than 70-years (42.4%; mean age, 66.8 years), with BCLC stage C (80.8%) and chronic
hepatitis C (50.5 %). The majority of the patients received TAE therapy (40.4 %), and about one-fourth

(24.2%) of the patients did not receive any therapy. Patients with BCLC stage C had larger tumor size, more
macrovascular invasion, and more extrahepatic spreading when compared to those with BCLC stage B.

Our findings are similar to the results reported by many published studies. The overall median survival

time was significantly longer in patients with BCLC stage B than those with BCLC stage C (41 months
versus 10 months). The one-year survival rate was also significantly higher in the BCLC stage B than in the
stage C groups (42.1% versus 16.3%). In addition, the disease control rate was also significantly higher in
the BCLC stage B than stage C groups (47.4% versus 20%). All patients had drug-related adverse events,

referring particularly to fatigue. We had only one incidence of grade 4 liver dysfunction in the BCLC stage
C group, and the patient was discontinued from the Nexavar therapy.

With our retrospective and observational study, the findings from this study suggest that early target

therapy can be helpful to the patients with advanced HCC. Taitung, located in southeastern Taiwan is a
long-striped county and city. Due to poor health knowledge, relatively low socioeconomic status, high rates
of alcohol abuse, and limited access to healthcare in the past, we have more cases of advanced HCC than the
rest of the areas in Taiwan. We would try our best to perform hepatitis and hepatoma screening at the rural

area in Taitung in an attempt to reduce future incidences of advanced HCC.