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Erschienen in: Journal of Cancer Research and Clinical Oncology 2/2018

16.12.2017 | Original Article – Clinical Oncology

Metronomic capecitabine as second-line treatment for hepatocellular carcinoma after sorafenib discontinuation

verfasst von: Franco Trevisani, Giovanni Brandi, Francesca Garuti, Maria Aurelia Barbera, Raffaella Tortora, Andrea Casadei Gardini, Alessandro Granito, Francesco Tovoli, Stefania De Lorenzo, Andrea Lorenzo Inghilesi, Francesco Giuseppe Foschi, Mauro Bernardi, Fabio Marra, Rodolfo Sacco, Giovan Giuseppe Di Costanzo

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 2/2018

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Abstract

Purpose

Metronomic capecitabine (MC) is a well-tolerated systemic treatment showing promising results in one retrospective study, as second-line therapy after sorafenib failure, in patients with hepatocellular carcinoma (HCC).

Methods

117 patients undergoing MC were compared to 112 patients, eligible for this treatment, but undergoing best supportive care (BSC) after sorafenib discontinuation for toxicity or HCC progression. The two groups were compared for demographic and clinical features. A multivariate regression analysis was conducted to detect independent prognostic factors. To balance confounding factors between the two groups, a propensity score model based on independent prognosticators (performance status, neoplastic thrombosis, causes of sorafenib discontinuation and pre-sorafenib treatment) was performed.

Results

Patients undergoing MC showed better performance status, lower tumor burden, lower prevalence of portal vein thrombosis, and better cancer stage. Median (95% CI) post-sorafenib survival (PSS) was longer in MC than in BSC patients [9.5 (7.5–11.6) vs 5.0 (4.2–5.7) months (p < 0.001)]. Neoplastic thrombosis, cause of sorafenib discontinuation, pre-sorafenib treatment and MC were independent prognosticators. The benefit of capecitabine was confirmed in patients after matching with propensity score [PSS: 9.9 (6.8–12.9) vs. 5.8 (4.8–6.8) months, (p = 0.001)]. MC lowered the mortality risk by about 40%. MC achieved better results in patients who stopped sorafenib for adverse events than in those who progressed during it [PSS: 17.3 (10.5–24.1) vs. 7.8 (5.2–10.1) months, (p = 0.035)]. Treatment toxicity was low and easily manageable with dose modulation.

Conclusions

MC may be an efficient and safe second-line systemic therapy for HCC patients who discontinued sorafenib for toxicity or tumor progression.
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Metadaten
Titel
Metronomic capecitabine as second-line treatment for hepatocellular carcinoma after sorafenib discontinuation
verfasst von
Franco Trevisani
Giovanni Brandi
Francesca Garuti
Maria Aurelia Barbera
Raffaella Tortora
Andrea Casadei Gardini
Alessandro Granito
Francesco Tovoli
Stefania De Lorenzo
Andrea Lorenzo Inghilesi
Francesco Giuseppe Foschi
Mauro Bernardi
Fabio Marra
Rodolfo Sacco
Giovan Giuseppe Di Costanzo
Publikationsdatum
16.12.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Cancer Research and Clinical Oncology / Ausgabe 2/2018
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-017-2556-6

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