Page 68 - Read Online
P. 68
showed that in elderly HCC patients with cirrhosis, sorafenib important to make any decisions on treatment through a
is as safe and effective as in younger patients. No unexpected multidisciplinary team that includes experts in liver disease
adverse events related to advanced age were observed. and in clinical oncology to perform a personal non-protocol
Temporary and permanent sorafenib discontinuations were approach for the oncological care and management of elderly
more frequent in older than in younger patients. However, patients with HCC. However, elderly patients with good
this difference did not turn out to be statistically significant. clinical conditions should be treated with sorafenib.
A recently published retrospective study on 129 patients REFERENCES
compared the efficacy and safety of sorafenib in HCC patients
[16]
with different ages (≥ 70 and < 70 years). The efficacy and 1. International Agency for Research on Cancer. GLOBOCAN 2012
the overall safety were found to be similar between the two Cancer Fact Sheets. Available from: http://www.globocan.iarc.fr/Pages/
groups. Asthenia and bleeding were more frequent in older 2. fact_sheets_cancer.aspx. [Last cited on 2015 Apr 27].
El-Serag HB. Hepatocellular carcinoma. N Engl J Med 2011;365:1118-27.
patients as a result of a higher use of platelet aggregation 3. Michielsen PP, Francque SM, van Dongen JL. Viral hepatitis and
inhibitors in this population. hepatocellular carcinoma. World J Surg Oncol 2005;3:27.
4. Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide
incidence and trends. Gastroenterology 2004;127:S5-16.
The efficacy and safety of sorafenib in patients ≥ 80 years 5. Degos F, Christidis C, Ganne-Carrie N, Farmachidi JP, Degott C,
old were examined in a multicenter Japanese retrospective Guettier C, Trinchet JC, Beaugrand M, Chevret S. Hepatitis C virus
study. [17] One hundred and eighty-five patients were related cirrhosis: time to occurrence to hepatocellular carcinoma and
reviewed, 24 of them being ≥ 80 years old and 161 6. death. Gut 2000;47:131-6.
El-Serag HB, Davila JA, Petersen NJ, McGlynn KA. The continuing
being < 80 years old. Median overall survival was increase in the incidence of hepatocellular carcinoma in the United
greater in older patients (11.7 months) than compared to States: an update. Ann Intern Med 2003;139:817-23.
those < 80 years old (10.5 months), with a good tolerability 7. Yancik R, Ganz PA, Varricchio CG, Conley B. Perspectives on
in both groups. comorbidity and cancer in the older patient: approach to expend the
knowledge base. J Clin Oncol 2001;19:1147-51.
8. Dale W, Mohile SG, Eldadah BA, Trimble EL, Schilsky RL, Cohen HJ,
Many elderly patients are frail. Frailty implies a reduced organ Muss HB, Schmader KE, Ferrell B, Extermann M, Nayfield SG,
function, the presence of comorbidities and impairment of Hurria A; Cancer and Aging Research Group. Biological, clinical, and
physical function. Concomitant assumption of different psychosocial correlates at the interface of cancer and aging research.
[7]
J Natl Cancer Inst 2012;104:581-9.
drugs could moreover interfere with sorafenib absorption. 9. Townsley CA, Pond GR, Oza AM, Hirte HW, Winquist E, Goss G,
However, studies on the use of sorafenib in the elderly Degendorfer P, Moore MJ, Siu LL. Evaluation of adverse events
suggest overcoming the predisposition to consider older experienced by older patients participating in studies of molecularly
targeted agents alone or in combination. Clin Cancer Res 2006;12:2141-9.
patients associated with poor prognosis and poor tolerance 10. European Association for the Study of the Liver; European Organisation
to drugs. In these first experiences, in fact, efficacy and for Research and Treatment of Cancer. EASL-EORTC clinical practice
safety of sorafenib do not seem influenced by the age. All guidelines: management of hepatocellular carcinoma. J Hepatol
elderly patients undergoing sorafenib treatment should be 2012;56:908-43.
strictly monitored to evaluate physical (blood pressure, vital 11. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de
Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C,
signs) and laboratory parameters to prevent and promptly Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I,
manage adverse events. Dose adjustments, in order to Häussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J;
alleviate adverse events, may be a successful strategy to SHARP Investigators Study Group. Sorafenib in advanced hepatocellular
carcinoma. N Engl J Med 2008;359:378-90.
avoid permanent discontinuation and maximize the benefit 12. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J,
of the drug. Ye S, Yang TS, Xu J, Sun Y, Liang H, Liu J, Wang J, Tak WY, Pan H,
Burock K, Zou J, Voliotis D, Guan Z. Effi cacy and safety of sorafenib
A comprehensive geriatric assessment (CGA) should be in patients in the Asia-Pacifi c region with advanced hepatocellular
performed by geriatricians to evaluate the functional and carcinoma: a phase III randomized, double-blind, placebo controlled
trial. Lancet Oncol 2009;10:25-34.
global health status of these elderly patients because CGA 13. Lencioni R, Kudo M, Ye SL, Bronowicki JP, Chen XP, Dagher L,
results are closely related to the prognosis of elderly patients Furuse J, Geschwind JF, de Guevara LL, Papandreou C, Takayama T,
in general. Yoon SK, Nakajima K, Lehr R, Heldner S, Sanyal AJ. GIDEON (Global
Investigation of therapeutic DEcisions in hepatocellular carcinoma and
Of its treatment with sorafeNib): second interim analysis. Int J Clin
CONCLUSION Pract 2014;68:609-17.
14. Di Costanzo GG, Tortora R, De Luca M, Galeota Lanza A, Lampasi F,
Given the challenges of managing the complexity of HCC Tartaglione MT, Picciotto FP, Imparato M, Mattera S, Cordone G,
often associated with underlying liver disease and the Ascione A. Impact of age on toxicity and effi cacy of sorafenib-targeted
therapy in cirrhotic patients with hepatocellular carcinoma. Med Oncol
complex health conditions of elderly patients, it is extremely 2013;30:446.
Hepatoma Research | Volume 1 | Issue 2 | July 15, 2015 61