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Review

Hepatocellular carcinoma in elderly patients: a concise review
Hepatocellular carcinoma in elderly patients: a concise review
on systemic therapy with sorafenib
on systemic therapy with sorafenib

Lombardi Giuseppe , Vitale Alessandro , Sara Lonardi , Bellu Luisa , Pambuku Ardi ,
1
2
1
1
1
Marsico Valentina , Crivellari Gino , Aliberti Camillo , Cillo Umberto , Zagonel Vittorina 1
3
2
1
1
1 Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology-IRCCS, 35128 Padua, Italy
2 Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
3 Interventional Oncology Unit, Veneto Institute of Oncology-IRCCS, 35128 Padua, Italy
ABSTRACT
The treatment of hepatocellular carcinoma (HCC) in elderly patients is unclear. In particular, the effi cacy and safety of
sorafenib as a systemic treatment in these patients is still under debate. We performed a concise review of sorafenib therapy
in this population. However, it is important to make any decisions on treatment for elderly patients with HCC through a
multidisciplinary team that includes experts in the liver disease. Patients with good clinical conditions should be treated
with sorafenib.

Key words: Hepatocellular carcinoma; sorafenib; treatment; chemotherapy; elderly patients

Address for correspondence:
Dr. Lombardi Giuseppe, Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology-IRCSS,
Via Gattamelata, 64, 35128 Padua, Italy. E-mail: giuseppe.lombardi@ioveneto.it
Received: 17-02-2015, Accepted: 11-05-2015

INTRODUCTION exposure. Cirrhosis is another important risk factor, which
[4]
may be triggered by chronic viral hepatitis, alcohol or inherited
Hepatocellular carcinoma (HCC) is the fifth most common metabolic diseases. Therefore, in up to 90% of cases, HCC
solid organ malignancy worldwide and the second cause of becomes progressively worse on account of underlying liver
cancer-related mortality, with the highest incidence rates in areas diseases so that in most patients, prognosis and management
[1]
where hepatitis B virus infection is endemic such as South-East are influenced by the presence of two separate entities: Chronic
Asia and sub-Saharan Africa. Similar to other common cancers, hepatitis with or without cirrhosis and HCC. [3,5,6] Consequently,
[2]
the incidence of HCC increases in relation to age. In Western the choice of the appropriate HCC therapy should consider the
countries, it tends to peak at the age of 75 years and in the United limitations presented by underlying liver diseases.
States it rarely occurs before the age of 40 years. In Chinese and in
black African populations it generally occurs in younger patients. [2] In the most recent HCC guidelines (EASL/EORTC, AASLD,
AISF, AIOM), disease staging includes tumor characteristics,
underlying liver cirrhosis, and performance status. Treatment
Well-known risk factors typically characterize the development
of HCC. The most frequent conditions include chronic viral allocation is then based on these parameters. Patient age is
not taken into account though there is an increasing focus
hepatitis (types B and C), alcohol intake, and aflatoxin
[3]
on elderly patients. Due to the aging of the population,
this group represents the fastest growing segment of
Access this article online
Quick Response Code populations with cancer.
Website:
http://www.hrjournal.net/ The aim of this investigation was to review all the gathered
experience of using sorafenib, a targeted multikinase

DOI: inhibitor, in the treatment of HCC, with a focus on the
10.4103/2394-5079.157695 evaluation of safety and the efficacy of this agent in the
elderly as compared to younger patients.

58 Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015