Page 274 - Read Online

Lecchini et al. HCC vascular invasion in sorafenib treatment

of cancer cells, worsening of portal hypertension and Dalla Valle, G. Missale
liver function and poorer tolerance to treatment. As Statistical analysis: A. Olivani, G. Missale
evidence of this, majority of patients (71%) stopping Literature search and manuscript preparation: M.
treatment before radiologic evaluation presented this Lecchini
complication. Neoplastic macrovascular invasion was Manuscript editing: A. Olivani, C. Ferrari, G. Missale, C.
associated with a survival expectancy less than half, Schianchi
suggesting the usefulness to investigate alternative Manuscript review: C. Ferrari, G. Missale, C. Schianchi
treatments like combination of different therapies
modalities such as external radiotherapy or selective Financial support and sponsorship
internal radiation therapy [24] . Whether best supportive This work was supported by FIRB grant from the Italian
care may represent the best medical option may not be Ministry of the University and Research, Protocol
concluded on the base of our findings however it could RBAP10TPXK.
be considered in selected cases.
Conflicts of interest
Interestingly, sorafenib dose reduction and median There are no conflicts of interest.
daily dose less than 800 mg were positively associated
with survival, in fact patients that reduced dose during Patient consent
treatment showed a median survival of 11 months Consent was obtained from patients still alive at the
compared to 5 months of the remaining patients. time of data collection and analysis.
Similarly, it has been reported a survival of 21.6 months
compared to 9.6 months for patients treated for more Ethics approval
than 70% of the time at half dose [29] . Therefore, a The study was approved by the local ethical committee
lower dose may be advantageous, enabling a more (Comitato Etico Indipendente (IRB/IEC) of the Azienda
prolonged treatment, with no reduction of therapeutic Ospedaliero-Universitaria of Parma, Italy).
effect. In other studies [30,31] , starting dose, was analyzed
as a variable that could influence management and REFERENCES
efficacy of sorafenib showing longer time on treatment
and better survival for patients starting with full dose. 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global
However, in this study [31] median daily dose was not cancer statistics. CA Cancer J Clin 2011;61:61-9.
reported and is not clear if dose reductions allowed 2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM.
longer time on treatment and better outcome. Estimates of worldwide burden of cancer in 2008: GLOBOCAN
2008. Int J Cancer 2010;127:2893-917.
Treatment adverse events were not significantly 3. Schütte K, Bornschein J, Malfertheiner P. Hepatocellular carcinoma--
different compared to previous reports, registering at 4. epidemiological trends and risk factors. Dig Dis 2009;27:80-92.
Perz JF, Armstrong GL, Farrington LA, Hutin Yj, Bell BP. The
least one adverse effects in 91.5% of our patients. The contributions of hepatitis B virus and hepatitis C virus infections to
most common effects didn’t differ to what previously cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-
reported [14,28-30] , represented by asthenia, gastro- 38.
intestinal symptoms, in particular moderate or severe 5. Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A
diarrhea, hypertension and dermatological lesions as position statement on NAFLD/NASH based on the EASL 2009
systemic rash or HFSR. special conference. J Hepatol 2010;53:372-84.
6. Loria P, Adinolfi LE, Bellentani S, Bugianesi E, Grieco A, Fargion
S, Gasbarrini A, Loguercio C, Lonardo A, Marchesini G, Marra F,
In conclusion, portal neoplastic thrombosis is the most Persico M, Prati D, Baroni GS; NAFLD Expert Committee of the
important prognostic factor being associated with a Associazione Italiana per lo studio del Fegato. Practice guidelines for
rapid clinical deterioration leading to death. Finally, the diagnosis and management of non-alcoholic fatty liver disease:
we confirm the importance of clinical management for a decalogue from the Italian Association for the Study of the Liver
individualized treatment dose in order to provide longer (AISF) Expert Committee. Dig Liver Dis 2010;42:272-82.
treatment periods, that seems to be crucial to improve 7. Porepa L, Ray JG, Sanchez-Romeu P, Booth GL. Newly diagnosed
survival of our patients. diabetes mellitus as a risk factor for serious liver disease. CMAJ
2010;182:E526-31.
8. Polesel J, Zucchetto A, Montella M, Dal Maso L, Crispo A, La
DECLARATIONS Vecchia C, Serraino D, Franceschi S, Talamini R. The impact of
obesity and diabetes mellitus on the risk of hepatocellular carcinoma.
Authors’ contributions 9. Ann Oncol 2009;20:353-7.
Balogh J, Victor D 3rd, Asham EH, Burroughs SG, Boktour M,
Concept and design: G. Missale, C. Schianchi Saharia A, Li X, Ghobrial RM, Monsour HP Jr. Hepatocellular
Data acquisition: M. Lecchini, E. Biasini carcinoma: a review. J Hepatocell Carcinoma 2016;3:41-53.
Data analysis: M. Lecchini, A. Olivani, E. Biasini, R. 10. Colagrande S, Inghilesi AL, Aburas S, Taliani GG, Nardi C, Marra

266 Hepatoma Research ¦ Volume 3 ¦ November 16, 2017