Regorafenib Efficacy After Sorafenib in Patients With Recurrent Hepatocellular Carcinoma After Liver Transplantation: A Retrospective Study.

Safety of regorafenib in hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been recently demonstrated. We aimed to assess the survival benefit of regorafenib compared with best supportive care (BSC) in LT patients after sorafenib discontinuation. This observational multicenter retrospective study included LT patients with HCC recurrence who discontinued first-line sorafenib. Group 1 comprised regorafenib-treated patients, whereas the control group was selected among patients treated with BSC due to unavailability of second-line options at the time of sorafenib discontinuation and who were sorafenib-tolerant progressors (group 2). Primary endpoint was overall survival (OS) of group 1 compared with group 2. Secondary endpoints were safety and OS of sequential treatment with sorafenib + regorafenib/BSC. Among 132 LT patients who discontinued sorafenib included in the study, 81 were sorafenib tolerant: 36 received regorafenib (group 1) and 45 (group 2) received BSC. Overall, 24 (67%) patients died in group 1 and 40 (89%) in group 2: the median OS was significantly longer in group 1 than in group 2 (13.1 versus 5.5 months; P < 0.01). Regorafenib treatment was an independent predictor of reduced mortality (hazard ratio, 0.37; 95% confidence interval [CI], 0.16-0.89; P = 0.02). Median treatment duration with regorafenib was 7.0 (95% CI, 5.5-8.5) months; regorafenib dose was reduced in 22 (61%) patients for adverse events and discontinued for tumor progression in 93% (n = 28). The median OS calculated from sorafenib start was 28.8 months (95% CI, 17.6-40.1) in group 1 versus 15.3 months (95% CI, 8.8-21.7) in group 2 (P < 0.01). Regorafenib is an effective second-line treatment after sorafenib in patients with HCC recurrence after LT.

[Effectiveness of percutaneous drainage in the treatment of abdominal fluid collections in inflammatory pancreatic disease]. / Efectividad del drenaje percutáneo en el tratamiento de las colecciones abdominales asociadas con una enfermedad inflamatoria del páncreas.

AIMS: To assess the effectiveness of ultrasonography-guided percutaneous drainage (UGPD) in the management of fluid collections (FC) in acute and chronic pancreatitis, and to evaluate factors associated with treatment results. METHOD: Seventy-two patients with pancreatic fluid collections ranging from 5 to 20 cm (median 9 cm) were studied. There were 27 type I pseudocysts (PC), 12 type II PC, 13 type III PC, 16 abscesses, and 4 acute fluid collections. Catheters were placed in 60 patients and simple aspiration was performed in 8 patients. UGPD could not be performed in 4 patients. RESULTS: UGPD was curative in 39 patients (54.1%): 44.4% in type I PC, 83% in type II PC, 30.7% in type III PC, 62.5% in abscesses, and 75% in acute FC. Resolution was achieved in 35.7% of patients with pancreatic duct communication and in 71.4% of those with non-communicated FC. No differences in effectiveness were observed according to the etiology of pancreatitis, pancreatic duct obstruction, drainage method, or the number or size of FC. UGPD was effective in 45.8% of the procedures performed before 1993, in 58.3% of those performed between 1993 and 1999, and in 63.6% of those performed after 2000. The complication rate was 37.5% and all complications were mild. CONCLUSIONS: UGPD is an effective treatment for pancreatic FC. The effectiveness of this method depends on appropriate patient selection and careful management of acute pancreatitis. Outcomes were less favorable in patients with type III PC and in those with duct communication.

Efectividad del drenaje percutáneo en el tratamiento de las colecciones abdominales asociadas con una enfermedad inflamatoria del páncreas / Effectiveness of percutaneous drainage in the treatment of abdominal fluid collections in inflammatory pancreatic disease

Objetivos: Evaluar la efectividad del drenaje percutáneo (DP) guiado por ecografía en el tratamiento de las colecciones asociadas a pancreatitis y la existencia de factores determinantes de la utilidad de dicho tratamiento. Método: 72 pacientes con colecciones pancreáticas de 5-20 cm (mediana, 9 cm): 27 seudoquistes (SQ) tipo I, 12 tipo II y 13 tipo III, 16 abscesos y 4 colecciones agudas. Sesenta pacientes fueron tratados mediante la colocación de catéteres y 8 mediante aspiración simple. En 4 no se consiguió el DP. Resultados: En 39 casos (54,1%), el DP fue curativo: el 44,4% de los SQ tipo I, el 83% de los tipo II, el 30,7% de los tipo III, el 62,5% de los abscesos pancreáticos, el 75% de las colecciones agudas, el 35,7% de las comunicadas con el conducto pancreático y el 71,4% de las no comunicadas. No se observaron diferencias en función de la etiología de la pancreatitis, la presencia de obstrucción ductal, la técnica de drenaje, el número de colecciones ni el tamaño de éstas. El DP fue resolutivo en el 45,8% de los realizados antes de 1993, en el 58,3% de los llevados a cabo entre 1993 y 1999 y en el 63,6% de los realizados desde el año 2000. Se registró un 37,5% de complicaciones, todas leves. Conclusiones: El DP es una alternativa útil en el tratamiento de las colecciones asociadas a una enfermedad pancreática, cuya efectividad depende de una correcta selección de los pacientes y de una cuidadosa atención a las medidas asociadas al tratamiento de la pancreatitis aguda. Cabe esperar peores resultados en pacientes con SQ tipo III y otros comunicados con el conducto pancreático

Aims: To assess the effectiveness of ultrasonography-guided percutaneous drainage (UGPD) in the management of fluid collections (FC) in acute and chronic pancreatitis, and to evaluate factors associated with treatment results. Method: Seventy-two patients with pancreatic fluid collections ranging from 5 to 20 cm (median 9 cm) were studied. There were 27 type I pseudocysts (PC), 12 type II PC, 13 type III PC, 16 abscesses, and 4 acute fluid collections. Catheters were placed in 60 patients and simple aspiration was performed in 8 patients. UGPD could not be performed in 4 patients. Results: UGPD was curative in 39 patients (54.1%): 44.4% in type I PC, 83% in type II PC, 30.7% in type III PC, 62.5% in abscesses, and 75% in acute FC. Resolution was achieved in 35.7% of patients with pancreatic duct communication and in 71.4% of those with non-communicated FC. No differences in effectiveness were observed according to the etiology of pancreatitis, pancreatic duct obstruction, drainage method, or the number or size of FC. UGPD was effective in 45.8% of the procedures performed before 1993, in 58.3% of those performed between 1993 and 1999, and in 63.6% of those performed after 2000. The complication rate was 37.5% and all complications were mild. Conclusions: UGPD is an effective treatment for pancreatic FC. The effectiveness of this method depends on appropriate patient selection and careful management of acute pancreatitis. Outcomes were less favorable in patients with type III PC and in those with duct communication