Sorafenib Continuation after First Disease Progression Could Reduce Disease Flares and Provide Survival Benefits in Patients with Hepatocellular Carcinoma: a Pilot Retrospective Study

Background: Sorafenib is a promising drug for advanced hepatocellular carcinoma (HCC); however,treatment may be discontinued for multiple reasons, such as progressive disease, adverse events, or the costof treatment. The consequences of sorafenib discontinuation and continuation are uncertain. Materials and
Methods: We retrospectively analyzed 88 HCC patients treated with sorafenib from July 2007 to January 2013.Overall survival (OS), post-disease progression overall survival (pOS), and time to disease progression (TTP)were compared for survival analysis. Cox proportional hazard regression was performed to assess the effectof important factors on OS in the overall patient population and on pOS in patients who continued sorafenibtreatment.
Results: Sorafenib was discontinued and continued in 24 and 64 patients, respectively. The medianOS (355 vs 517 days respectively; p=0.015) and median post-PD OS (260 vs 317 days, respectively; p=0.020) werestatistically different between the discontinuation and continuation groups. Neither the median time to first PDnor the time to second PD were significantly different between the 2 groups. In the discontinuation group, 3 of the24 patients (12.5%) suffered disease outbreaks. In Cox proportional hazard regression analysis after correctionfor confounding factors, BCLC stage (p=0.002) and PD site (p=0.024) were significantly correlated with pOS inpatients who continued sorafenib treatment.
Conclusions: Sorafenib discontinuation may cause HCC flares oroutbreaks. It is advisable to continue sorafenib treatment after first PD, particularly in patients with BarcelonaClinic Liver Cancer stage B disease or only intrahepatic PD.