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von Felden, Johann; Karkmann, Kathrin; Ittrich, Harald; Gil-Ibanez, Ines; Fründt, Thorben; Krause, Jenny; Lohse, Ansgar W.; Wege, Henning; Schulze, Kornelius

Sequential Systemic Treatment in Advanced Hepatocellular Carcinoma Is Able to Prolong Median Survival to More than 3 Years in a Selected Real-World Cohort

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  • Medientyp: E-Artikel
  • Titel: Sequential Systemic Treatment in Advanced Hepatocellular Carcinoma Is Able to Prolong Median Survival to More than 3 Years in a Selected Real-World Cohort
  • Beteiligte: von Felden, Johann; Karkmann, Kathrin; Ittrich, Harald; Gil-Ibanez, Ines; Fründt, Thorben; Krause, Jenny; Lohse, Ansgar W.; Wege, Henning; Schulze, Kornelius
  • Erschienen: S. Karger AG, 2021
  • Erschienen in: Visceral Medicine
  • Sprache: Englisch
  • DOI: 10.1159/000507381
  • ISSN: 2297-475X; 2297-4725
  • Schlagwörter: Gastroenterology ; Surgery
  • Entstehung:
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  • Beschreibung: <jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; The number of efficacious systemic agents for advanced hepatocellular carcinoma (HCC) has rapidly increased over the past 3 years. However, guidance for optimal sequential systemic treatment in patients with advanced disease and experience with outcome and safety profiles are lacking. &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; We aimed to assess efficacy and tolerability of sequential systemic therapy of advanced HCC. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Our single-center study prospectively followed 14 patients who received multiple, sequential systemic therapies after progression or intolerance to sorafenib. Endpoints were overall and progression-free survival (OS, PFS), objective response rate (ORR), and treatment-emergent adverse events (TEAE). &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Patients had well-compensated liver function and good performance status at start of each systemic therapy. Agents included sorafenib (&lt;i&gt;n&lt;/i&gt; = 14), regorafenib (&lt;i&gt;n&lt;/i&gt; = 10), immunotherapy with nivolumab or pembrolizumab (&lt;i&gt;n&lt;/i&gt; = 10), lenvatinib (&lt;i&gt;n&lt;/i&gt; = 3), ramucirumab (&lt;i&gt;n&lt;/i&gt; = 2), and others, with a median of 3 lines of systemic therapy per patient. Median OS was 37.4 months from initiation of first-line therapy with sorafenib. PFS and ORR for sorafenib, regorafenib, and immunotherapy were 6.6, 5.3, and 6.6 months, and 15.4, 11.1, and 22.2%, respectively. TEAE were frequent (46–80%), but mostly manageable during tyrosine kinase inhibitor therapy and without the need for termination in most patients. However, TEAE due to immunotherapy (60%) led to cessation of treatment in 40% of the patients. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Sequential systemic therapy is able to prolong median OS in selected patients with advanced HCC to more than 3 years. TEAE are frequent, but manageable, and the quality of adverse events depends on the respective agent. Further investigation of potential predictive biomarkers for treatment allocation is needed. </jats:p>