ASCO 2015

Transarterial chemoembolization with or without sorafenib for intermediate-stage hepatocellular carcinoma

Prof Guohong Han - Xijing Hospital, Fourth Military Medical University, Xi'an, China

You have been looking at hepatocellular carcinoma and looking at sorafenib and TACE. Can you tell me, why were you interested in combining transarterial embolization with sorafenib? What was the question you were looking at?

As we know, the standard therapy for intermediate stage HCC as the guidelines tell us is TACE for intermediate stage HCC. Meanwhile for the advanced stage HCC the standard therapy is sorafenib. After the sorafenib came to the market we became concerned – is it possible to combine TACE with sorafenib? Is it better than TACE alone for intermediate stage HCC?

Now there were no clear data up until now. You have put this to test, you’ve been studying this. What did you do?

As we know, previously there is some data on the combination therapy but the result is not as good as expected. The reason is when we combine them together, compared with TACE alone we don’t consider the responders and non-responders to sorafenib. We go to the results, not so good as we expected. So this time we combined sorafenib and TACE compared with TACE alone for intermediate stage. We emphasised the responders to sorafenib in the group of combination therapy.

How did you measure response because adverse effects were part of this, weren’t they?

Yes. Actually, as we know the adverse events are not good for the patients. But, on the other hand, if we concern the effects of the agents maybe the adverse events are a clinical marker to the agents such as sorafenib. So we defined the adverse events only as a hand foot skin reaction or the rash. That is a dermatological reaction to the sorafenib.

So what you’re saying is that if your patient gets a dermatological reaction then the sorafenib is probably working. What happened, in fact, in your study? What did you find?

In the responders which means having the dermatological adverse events to the sorafenib, this subgroup of patients in the combination therapy the survival is better than the TACE alone. But if we compare the whole cohort group compared with sorafenib there is no significant difference in survival. So we compared the subgroup in the responders to sorafenib, we had a prolonged survival than the TACE alone group.

What, then, do you think doctors should now be doing for patients with intermediate stage hepatocellular carcinoma with a view to using TACE and sorafenib together? What should they be doing?

Yes. For our study we inferred from our study that patients in the combination group the result is no different in the combination group. For the patients with responders to sorafenib it might be the results are better than the patients non-responding. So for intermediate stage HCC maybe a combination therapy, by which we mean TACE and sorafenib, may be better than TACE alone for the patients with responders to sorafenib.

You say maybe, that’s a big word. If you’re a busy cancer doctor, you give your patients sorafenib, they do get a dermatological response, should you go for TACE together with sorafenib?

Yes, if the patients respond to sorafenib with a dermatological response we can continue the sorafenib therapy and combine it with TACE together for the patients.

So what’s the bottom line message that you give doctors coming here from ASCO about your trial?

Of course the trial, we should have a prospective multi-centre trial to compare the combination group with responders to the TACE alone further data are warranted. After the further data we have we can recommend doctors to have the combination therapy for intermediate stage HCC.