Management of cirrhotic patients with hepatocellular carcinoma treated with sorafenib

Abstract

Sorafenib (Nexavar^®, Bayer), a multi-targeted tyrosine kinase inhibitor, was the first systemic agent that demonstrated a significant improvement in the overall survival in patients with advanced hepatocellular carcinoma and well-preserved liver function. This drug is now recommended in patients with advanced hepatocellular carcinoma as first-line therapy and for patients not suitable for locoregional treatment. This brief article, produced by a multidisciplinary panel including specialists in gastroenterology and oncology, provides an overview of the major issues related to systemic treatment of hepatocellular carcinoma with sorafenib, including staging and prognostic strategies, assessment of liver disease and its complications, and efficacy and safety of this molecule. Particular emphasis is given on how to improve tolerability of sorafenib in difficult-to-treat patients.

Keywords::

• cirrhosis
• hepatocellular carcinoma
• liver cancer
• management
• sorafenib
• systemic therapy
• treatment

Acknowledgements

The members of the HCC Working Group are: Stefano Fagiuoli (Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo), Giorgio Astara (Azienda Ospedaliero, Universitaria di Cagliari, Cagliari), Fabio Bassi (Arcispedale S. Maria Nuova, Azienda Ospedaliera di Reggio Emilia, Reggio Emilia), Marco Bazzica (Azienda Ospedaliera, Universitaria San Martino, Genova), Sherrie Bhoori (Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano), Giuseppe Cabibbo (Università degli Studi di Palermo, Palermo), Renato Cannizzaro (Centro di Riferimento Oncologico, Aviano [PN]), Carmine Coppola (Ospedale di Gragnano, Gragnano [NA]), Massimo De Giorgio (Azienda Ospedaliera, Ospedali Riuniti di Bergamo, Bergamo), Carlo De Sangro (Ospedale San Gennaro, Napoli), Maurizio Di Bisceglie (Azienda Ospedaliero Universitaria, Ospedali Riuniti di Foggia, Foggia), Tiziana Pressiani (Istituto Clinico Humanitas, Rozzano [MI]), Gian Lodovico Rapaccini (Policlinico Universitario, Agostino Gemelli, Roma), Emanuela Rolle (Azienda Ospedaliero Universitaria Molinette, San Giovanni Battista, Torino), Rodolfo Sacco (Azienda Ospedaliero Universitaria Pisana, Pisa), Giancarlo Serra (Università di Cagliari, Cagliari), Marianna Silletta (Università Campus, Bio-Medico di Roma, Roma), Francesca Spada (Università degli Studi di Sassari, Sassari), Diego Tempesta (Ospedale dell’Angelo, Venezia-Mestre [VE]), Giovanni Vallone (Azienda Ospedaliera di Cosenza, Cosenza) and Teresa Zolfino (Azienda Ospedaliera G Brotzu, Cagliari).

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Editorial assistance for the preparation of this manuscript was provided by Luca Giacomelli, PhD, of Content Ed Net; this assistance was funded by Bayer Italy.