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Experience With Early Sorafenib Treatment With mTOR Inhibitors in Hepatocellular Carcinoma Recurring After Liver Transplantation.
Invernizzi, Federica; Iavarone, Massimo; Zavaglia, Claudio; Mazza, Stefano; Maggi, Umberto; Cesarini, Lucia; Antonelli, Barbara; Airoldi, Aldo; Manini, Matteo Angelo; Sangiovanni, Angelo; Rossi, Giorgio; Donato, Maria Francesca; Saverio Belli, Luca; Lampertico, Pietro.
  • Invernizzi F; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan.
  • Iavarone M; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan.
  • Zavaglia C; Hepatology and Gastroenterology Department, Niguarda Ca' Granda Hospital, Milan.
  • Mazza S; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan.
  • Maggi U; University of Milan.
  • Cesarini L; HBP Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan.
  • Antonelli B; Hepatology and Gastroenterology Department, Niguarda Ca' Granda Hospital, Milan.
  • Airoldi A; HBP Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan.
  • Manini MA; Hepatology and Gastroenterology Department, Niguarda Ca' Granda Hospital, Milan.
  • Sangiovanni A; Gastroenterology, Hepatology and Transplant Unit, Department of Specialty and Transplant Medicine Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.
  • Rossi G; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan.
  • Donato MF; HBP Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan.
  • Saverio Belli L; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan.
  • Lampertico P; Hepatology and Gastroenterology Department, Niguarda Ca' Granda Hospital, Milan.
Transplantation ; 104(3): 568-574, 2020 03.
Article en En | MEDLINE | ID: mdl-31517781
ABSTRACT

BACKGROUND:

Sorafenib (SOR) is currently used for hepatocellular carcinoma (HCC) recurring after liver transplantation (LT) when HCC is unsuitable for surgical/locoregional treatments. We evaluated safety and effectiveness of early introduction of SOR after HCC-recurrence.

METHODS:

All patients with HCC-recurrence after LT treated with SOR in 2 centers were included (January 2008 to June 2018). Baseline and on-treatment data were collected.

RESULTS:

Fifty patients early treated with SOR for HCC-recurrence after LT (74% mammalian target of rapamycin inhibitor [mTORi], 54% HCC-treated at baseline) were enrolled. During 7.3 (0.3-88) months of SOR, all patients had at least one adverse event (AE), 56% graded 3-4. SOR was reduced in 68%, being AEs the main cause of reduction, and discontinued in 84% (60% symptomatic progression, 33% AE). Objective response was obtained in 16% and stable disease in 50%. Median time to radiological progression was 6 months (95% confidence Interval [CI], 4-8). Thirty-three patients (69%) died, 94% for HCC progression. Median overall survival (OS) was 18 months (95% CI, 8-27); 5-year OS was 18% (95% CI, 4%-32%). Baseline predictors of OS were SOR+mTORi (hazard ratio [HR], 0.4; 95% CI, 0.2-0.9; P = 0.04), previous curative treatments (HR, 0.3; 95% CI, 0.2-0.7; P = 0.003) and alpha-fetoprotein > 100 ng/mL (HR, 2.5; 95% CI, 1.1-5.0, P = 0.02). At multivariate analysis, HCC curative treatment was the only independent predictor (HR, 0.4; 95% CI 0.2-1.0; P = 0.04).

CONCLUSIONS:

Early and combined treatment with SOR and mTORi resulted in a favorable safety profile, while its effectiveness should be confirmed by meta-analysis of previous studies or by larger studies. Curative treatment for HCC resulted the only independent predictor of OS.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Protocolos de Quimioterapia Combinada Antineoplásica / Trasplante de Hígado / Carcinoma Hepatocelular / Sorafenib / Neoplasias Hepáticas / Recurrencia Local de Neoplasia Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Idioma: En Año: 2020 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Protocolos de Quimioterapia Combinada Antineoplásica / Trasplante de Hígado / Carcinoma Hepatocelular / Sorafenib / Neoplasias Hepáticas / Recurrencia Local de Neoplasia Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Idioma: En Año: 2020 Tipo del documento: Article