Patients with advanced hepatocellular carcinoma who failed first-line therapy may have benefited from having liver reserves of Child-Turcotte-Pugh class A or being eligible for clinical trials to improve their prognosis for overall survival, according to study data.
Researchers at National Taiwan University Hospital studied 192 patients with advanced hepatocellular carcinoma (HCC) who were involved in six clinical trials from May 2005 to May 2011 to assess first-line systemic therapy. The patients (median age, 56.9 years; 89% men) all had locally advanced or metastatic disease and had not responded to loco-regional treatment.
Therapies included: sorafenib vs. brivanib; sorafenib vs. sunitinib; sorafenib and tegafur/uracil; bevacizumab and capecitabine; bevacizumab and erlotinib; and thalidomide and tegafur/uracil. Before these first-line treatments, all the patients were required to have had Child-Turcotte-Pugh (CTP) class A liver reserves and Cancer of the Liver Italian Program scores of 4 or less. Thirty-four percent of the patients had CTP class B liver reserves and 2% had class C reserves.
By October 2012, 175 patients had died, and the entire cohort’s median overall survival (OS) after treatment failure was 4 months (95% CI, 2.7-5.3 months). Patients with CTP class A liver reserves had longer OS than patients with CTP class B or C reserves (median, 7.5 vs. 1.3 vs. 1 month; P<.001).
Researchers said 41% to 56% of patients were eligible for second-line therapy, and those who were potentially eligible for clinical trials had longer OS (median OS, 7.8-8.6 months) compared with ineligible patients.
“Patients with advanced HCC are likely to have deteriorating liver reserves and poor prognosis when first-line treatment fails,” the researchers wrote. “However, selected patients who have Child-Turcotte-Pugh class A liver function or who are potentially eligible for clinical trials may have substantially improved prognosis.”
Disclosure: The researchers report no relevant financial disclosures.