Comparison of FOLFOX/CAPOX and Sorafenib in Locally Advanced or Metastatic Hepatocellular Carcinoma

Year 2024, Volume: 77 Issue: 4, 362 - 366, 29.12.2024

Merih Yalçıner

Abstract

Objectives: Liver cancer ranks third in terms of mortality worldwide. Sorafenib is a tyrosine kinase inhibitor that was approved for patients with
advanced hepatocellular cancer (HCC). There are not many large-scale studies comparing sorafenib with chemotherapy. We planned to compare the
effectiveness of sorafenib and chemotherapy in advanced-stage HCC patients.

Materials and Methods: Patients over the age of 18, who were followed up with a diagnosis of advanced stage HCC in the Medical Oncology Department
at Ankara University Faculty of Medicine between 2012 and 2022, who received sorafenib or FOLFOX/CAPOX treatment as first-line treatment, were
included in the study. Patient and disease characteristics were recorded from the hospital database (Avicenna) and compared statistically.

Results: Forty-four patients were included. The Eastern Cooperative Oncology Group performance status of all patients was 0-1. Nine (22.5%) patients
had liver cirrhosis. The distribution of Child-Pugh scores was similar between groups (p=0.45). It was seen that 22 (50%) patients had stage A-B disease
and 22 (50%) patients had stage C disease. It was recorded that 37 (84.1%) patients received sorafenib and 7 (15.9%) patients received FOLFOX/CAPOX
treatment. Progression-free survival was measured as 2 months for the FOLFOX/CAPOX arm and 1 month for the sorafenib arm (p=0.96, log-rank).
Overall survival was measured as 8.8 months in the FOLFOX/CAPOX arm and 6.3 months in the sorafenib arm (p=0.29, log-rank).

Conclusion: No difference in survival was demonstrated between sorafenib and FOLFOX/CAPOX treatment. Multicenter and larger population studies
are needed to elucidate the place of fluoropyrimidine and oxaliplatin combination in HCC treatment.

Keywords

Hepatocellular carcinoma , liver cancer , chemotherapy , sorafenib

Project Number

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Lokal İleri veya Metastatik Hepatoselüler Karsinomda FOLFOX/CAPOX ve Sorafenib Karşılaştırması

Abstract

Amaç: Karaciğer kanseri, akciğer ve kolorektal kanserden sonra dünya çapında mortalite açısından üçüncü sırada yer almaktadır. Sorafenib, 2007
yılında inoperabl hepatoselüler kanser (HCC) hastalarında onay almış bir tirozin kinaz inhibitörüdür. Sorafenibin kemoterapi ile kıyaslandığı geniş
çaplı fazla sayıda çalışma olmadığı görülmektedir. Bu çalışmada ileri evre HCC hastalarında sorafenib ile kemoterapi etkinliğinin karşılaştırılması
planlandı.

Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi, Tıbbi Onkoloji bölümünde 2012-2022 arasında ileri evre HCC tanısı ile takip edilen, birinci
basamak tedavide sorafenib veya FOLFOX/CAPOX tedavisi alan, 18 yaş üzerindeki hastalar çalışmaya dahil edildi. Hasta ve hastalık özellikleri hastane
veritabanından (Avicenna) kaydedildi ve istatistiki olarak karşılaştırıldı.

Bulgular: Çalışmaya 44 hasta dahil edildi. Tüm hastaların Doğu Kooperatif Onkoloji Grubu performans durumu 0-1 idi. Dokuz (%22,5) hastada
karaciğer sirozu mevcuttu. Tümör evreleri değerlendirildiğinde 22 (%50) hastada evre A-B, 22 (%50) hastada evre C hastalık olduğu görüldü.
Sistemik tedavilerde 37 (%84,1) hastanın sorafenib, 7 (%15,9) hastanın FOLFOX/CAPOX tedavisi aldığı kaydedildi. Child-Pugh skorlarının dağılımı
gruplar arasında benzerdi (p=0,45). Progresyonsuz sağkalım FOLFOX/CAPOX kolu için 2 ay, sorafenib kolu için 1 ay olarak ölçüldü (p=0,96, log-rank).
Genel sağkalım FOLFOX/CAPOX kolunda 8,8 ay, sorafenib kolunda ise 6,3 ay olarak ölçüldü (p=0,29, log-rank).

Sonuç: Sorafenib ile FOLFOX/CAPOX tedavisi arasında sağkalım açısından fark gösterilemedi. Fluoropirimidin ve okzaliplatin kombinasyonunun HCC
tedavisindeki yerinin aydınlatılması için çok merkezli ve daha geniş popülasyonlu çalışmalara gereksinim vardır.

Keywords

Hepatoselüler karsinom , karaciğer kanseri , kemoterapi , sorafenib

Ethical Statement

Ethics Committee Approval: The study was conducted in accordance with the Declaration of Helsinki and Regulations in drug research Ministry of Health, Goverment of Türkiye, January 29,1993. Ankara University Faculty of Medicine Ethics committee approved the study protocol (decision no.: İ03-280- 24, date:24.04.2024). Informed Consent: All patients signed informed consent to participate in retrospective studies before initial presentation. Acknowledgements: We would like to express our sincere gratitude to all professors and staff we work together in our clinic for their continuous support.

Supporting Institution

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Project Number

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Thanks

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