Tolerance and outcomes of sorafenib in elderly patients treated for advanced hepatocellular carcinoma

作者：Williet Nicolas; Clavel Lea; Bourmaud Aurelie; Verot Celine; Bouarioua Nadia; Roblin Xavier; Merle Philippe; Phelip Jean Marc

来源：Digestive and Liver Disease, 2017, 49(9): 1043-1049.

DOI：10.1016/j.dld.2017.06.008

• Elderly
• Hepatocellular carcinoma
• Safety
• Sorafenib

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.

• 出版日期2017-9