Transarterial chemoembolization plus sorafenib improves survival in unresectable HCC
Performing transarterial chemoembolization (TACE) in addition to sorafenib therapy yields a significant increase in progression-free survival (PFS) in patients with unresectable hepatocellular carcinoma (HCC) when compared with TACE alone, according to the results of the TACTICS* trial.
TACTICS randomized 156 patients to TACE plus sorafenib (n=80) or TACE alone (n=76). Those in the combination group were given sorafenib 400 mg once daily for 2–3 weeks prior to TACE, followed by 800 mg once daily during on-demand conventional TACE sessions until time to untreatable (unTACEable) progression (TTUP). TTUP was defined as untreatable tumour progression, transient deterioration to Child-Pugh C, or appearance of vascular invasion/extrahepatic spread (EHS).
Of the patients, 60 (38 percent) were categorized as Barcelona Clinic Liver Cancer (BCLC) stage A, with most having a single large (>5 cm) unresectable tumour and considered as good candidates for TACE. There were 18 patients (12 percent) categorized as BCLC stage C due to having performance status 1, despite the absence of vascular invasion/extrahepatic spread.
Median PFS, the first coprimary endpoint, was significantly better in the combination group than in the TACE-alone group (25.2 vs 13.5 months; p=0.006). The second coprimary endpoint of overall survival (OS) was not analysed because data did not reach maturity at the cutoff date (only 73.6 percent of OS events were reached).
TACE plus sorafenib was also associated with more favourable TTUP (26.7 vs 20.6 months; p=0.02). The corresponding OS at 1 year and 2 years were 96.2 percent and 82.7 percent in the combination group and 77.2 percent and 64.6 percent in the TACE-alone group. There were no unexpected toxicities.
The present data indicate that the combination of TACE plus sorafenib can improve clinical outcomes and represents a feasible treatment choice in unresectable HCC patients without vascular invasion/EHS who are good candidates for TACE, according to researchers.
*TACE Therapy In Combination with Sorafenib as compared with TACE alone in patients with HCC