studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 435A
From 2005 to 2008, 783 patients initially treated with TACE
in Seoul National University Hospital (Seoul, Korea) were
included in this study. Among them, 356 patients received
second TACE session (TACE-2) and 196 patients received
third TACE session (TACE-3) for recurred HCC. We assessed
MESIAH score at baseline and prior to each TACE session, and
designated patients into MESIAH transition group if MESIAH
score increased before each TACE session. Cox regression and
survival analysis were performed. Results: The mean age was
56.3 ± 10.3 and hepatitis B virus were present in 76.0%. There
were 43 (12.1%) patients in the pre-TACE-2 MESIAH transition
group. There were no significant differences of Model for Endstage
Liver Disease score (8.27 vs 8.89, P=0.28) and baseline
MESIAH score (5.14 vs 5.02, P=0.41) between MESIAH transition
and non-transition groups, respectively. MESIAH transition
group showed shorter overall survival than the MESIAH
non-transition group (6.0 versus 16.0 months, respectively;
hazard ratio, 1.73; 95% confidence interval, 1.20-2.41).
Similar results were observed when the definition of MESIAH
transition was applied before TACE-3. Conclusions: MESIAH
transition is a simple method which can be implicated in practice.
MESIAH transition identifies patients who are unsuitable
for retreatment with TACE and external validation is warranted.
Disclosures:
Yoon Jun Kim - Grant/Research Support: Bristol-Myers Squibb, Roche, JW Creagene,
Bukwang Pharmaceuticals, Handok Pharmaceuticals, Hanmi Pharmaceuticals,
Yuhan Pharmaceuticals; Speaking and Teaching: Bayer HealthCare
Pharmaceuticals, Gilead Science, MSD Korea, Yuhan Pharmaceuticals, Samil
Pharmaceuticals, CJ Pharmaceuticals, Bukwang Pharmaceuticals, Handok Pharmaceuticals
The following authors have nothing to disclose: Young Youn Cho, Su Jong Yu,
June Sung Lee, Jeong-Ju Yoo, Minjong Lee, Donghyeon Lee, Yuri Cho, Eun Ju
Cho, Jeong-Hoon Lee, Jung-Hwan Yoon
448
Survival of Patients with Advanced Hepatocellular Carcinoma
on Sorafenib: Retrospective Analysis from a
Single Asian Center
Yeonjung Ha, Danbi Lee, Ju Hyun Shim, Young-Suk Lim, Han Chu
Lee, Young-Hwa Chung, Yung Sang Lee, Kang Mo Kim; Asan
Medical Center, Seoul, Korea (the Republic of)
Background: Sorafenib is the current standard of care for
patients with advanced hepatocellular carcinoma (HCC);
however actual treatment pattern varies from region to region
as well as among physicians. Therefore, we retrospectively
investigated the practice pattern and compared the effect of
sorafenib on survival and progression with other treatment
strategies. Methods: We conducted a single center retrospective
study involving patients of Barcelona Clinic Liver Cancer
C stage HCC on sorafenib with or without other treatments.
Baseline characteristics, pre and intratreatment variables, and
features regarding sorafenib administration were evaluated.
The primary outcome measure was the overall survival (OS),
and time-to-progression (TTP) was also calculated according
to each treatment strategy. Results: A total of 658 patients
(mean age 54.5 years, 83.3% male) were analyzed, with 293
initially treated with sorafenib, 236 treated with transarterial
chemoembolization (TACE) at first then switched to sorafenib,
and 129 who received a combination therapy of TACE and
sorafenib. The baseline characteristics of patients at the time
of initial sorafenib administration were comparable across the
three groups, Tumor-Node-Metastasis stage was IV in 96.3%
and liver function was Child-Pugh A in 77.1%. The indication
for sorafenib administration was mostly distant metastasis
in all groups, 88.5% in the initial treatment group, 89.7%
in the switched group and 80.6% in the combination group
(p=0.43). The average dosage of sorafenib was similar across
the groups (mean, 661.6 mg, p=0.18), whereas the treatment
duration was significantly shorter in the switched group.
Patients were withdrawn from sorafenib mostly because of disease
progression, while 12.8% stopped the medication due
to adverse reactions, most commonly hand-foot skin reaction
(43.0%). The median OS was 11.8 months in sorafenib alone
as compared with 13.5 months in the switched group and
16.2 months in the combination group (p=0.13). In a subgroup
analysis of patients with portal vein invasion but not with distant
metastasis, combination therapy was associated with better OS
(p=0.001) and longer TTP (p=0.020). In a multivariate model,
only combined treatment strategy was significantly associated
with longer OS (odds ratio [OR], 0.33, p=0.007) and TTP (OR,
0.40; p=0.014). Conclusion: Neither switched therapy (TACE
to sorafenib) nor combined approach was associated with a
longer OS than sorafenib alone in patients with BCLC C HCC.
However, in a subset of patients with portal vein invasion but
not with distant metastasis, combined treatment with TACE and
sorafenib showed better survival.
Disclosures:
Young-Suk Lim - Advisory Committees or Review Panels: Bayer Healthcare, Gilead
Sciences; Grant/Research Support: Bayer Healthcare, BMS, Gilead Sciences,
Novartis
Han Chu Lee - Grant/Research Support: Medigen Biotechnology Co., Novartis,
Roche, Bayer HealthCare, Bristol-Myers Squibb, INC research, Boehringer Ingelheim,
Taiho Pharmaceutical Co., Yuhan Co.
The following authors have nothing to disclose: Yeonjung Ha, Danbi Lee, Ju Hyun
Shim, Young-Hwa Chung, Yung Sang Lee, Kang Mo Kim
449
In patients with hepatocellular carcinoma (HCC) and
macrovascular invasion (MVI) amenable to surgical
resection, a survival similar to that observed on
sorafenib can be achieved
Charlotte E. Costentin 1 , Eric Vibert 2 , Françoise Roudot-Thoraval 3 ,
Thomas Decaens 4 , Nathalie Ganne-Carrié 5 , Bernard Paule 2 ,
Christian Letoublon 6 , Mélanie Chiaradia 7 , Julien Calderaro 8 ,
Rene Adam 2 , Ivan Bricault 9 , Giuliana Amaddeo 1 , Daniel Cherqui
2 , Olivier Seror 10 , Didier Samuel 2 , Ariane Mallat 1 , Christophe
Duvoux 1 , Alexis Laurent 11 ; 1 Hepatology, Hôpital Henri Mondor,
Creteil, France; 2 Hepatobiliary surgery, Paul Brousse Hospital,
Villejuif, France; 3 Public Health, Henri Mondor Hospital, Creteil,
France; 4 hepato-gastroenterology, CHU Grenoble, Grenoble,
France; 5 Hepatology, Jean Verdier Hospital, Bondy, France; 6 Surgery,
CHU Grenoble, Grenoble, France; 7 Radiology, Henri Mondor
Hospital, Creteil, France; 8 Pathology, Henri Mondor Hospital,
Creteil, France; 9 Radiology, CHU Grenoble, Grenoble, France;
10 Radiology, Jean Verdier Hospital, Bondy, France; 11 Surgery,
Henri Mondor Hospital, Creteil, France
Introduction: A median survival of 8 months has been reported
in the SHARP trial in HCC+MVI treated with Sorafenib. In
contrast, surgical retrospective studies report overall survivals
ranging from 12 to 20 month in this setting. The aim of this
study was to describe characteristics and overall survival in
HCC+MVI patients treated with surgery or sorafenib as the
first treatment step. Methods: 142 patients with HCC+MVI,
without extra-hepatic spread, treated either with surgical resection
(group 1; n=75) or sorafenib (group 2; n=67) in 4 French
centers as first-line treatment after diagnosis of MVI were retrospectively
reviewed. Results: Compared to patients in group
2, patients in group 1 were younger (58.3±11.7 vs 65.5±9.6
years, p