Transarterial chemoembolization, sorafenib are one powerful pair

Combining transarterial chemoembolization (TACE) with sorafenib in treating patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) could improve overall survival rates, according to a study published online April 6 by Radiology.

The occurrence of PVTT with HCC is fairly common, cropping up in 44 percent of patients at time of death and 10 to 40 percent of patients at time of diagnosis. Respective trials have demonstrated benefits of utilizing TACE and the tyrosine kinase inhibitor, sorafenib in this demographic.

“Recently, there has been increasing interest in combining TACE and sorafenib to potentially increase the efficacy of therapy in patients with intermediate- or advanced-stage HCC,” wrote lead author Kangshun Zu, MD, of the Sun Yat-sen University in Guangdong, China, and colleagues. “However, few reports exist that focus on the effects of combined TACE and sorafenib in the treatment of patients with HCC, with the location and extent of PVTT as the main variable being assessed.”

The researchers therefore aimed to investigate the role of TACE-sorafenib in patients with HCC and different types of PVTT by retrospectively evaluating medical records of 91 patients with HCC and PVTT who underwent TACE-sorafenib. Patient outcomes were then compared between those who underwent the treatment combination and those who underwent TACE.

The types of PVTT were divided into three groups: type A, which was PVTT in the main portal vein; type B, which was PVTT in the first-order portal vein branch; and type C, which was PVTT in second or lower-order portal vein branches.

Of the study group, 46 patients underwent TACE-sorafenib and 45 underwent TACE. Zu et al discovered that the combination treatment exhibited significant survival benefits in type B with a median survival of 13 months versus six months in those who underwent TACE. Significant survival benefits were also seen in type C, with a median survival of 15 months in those who underwent TACE-sorafenib and 10 months in those who underwent TACE.

Results also revealed that TACE-sorafenib and main PVTT were independent prognostic factors for survival. Liver function in patients with TACE-sorafenib declined only in patients with PVTT. Adverse events of grade three or higher that were related to sorafenib were evident in 16, or 35 percent, of patients.

“Our results imply that TACE-sorafenib could be a possible alternative treatment option in patients with HCC and PVTT in the first- or lower-order portal vein branches,” wrote the authors. “These patients have a longer tumor-to-tumor progression and overall survival in comparison with TACE alone and appear to benefit from the combined treatment. We do not, however, recommend TACE-sorafenib in patients with advanced HCC complicated by main PVTT,” they concluded.