Selection and management of hepatocellular carcinoma patients with sorafenib: recommendations and opinions from an Italian liver unit.

Sorafenib (SO) was the first systemic agent to demonstrate a significant improvement in overall survival in patients with advanced hepatocellular carcinoma (HCC); international guidelines now recommend SO as a first-line treatment in patients with unresectable HCC who are not eligible for locoregional therapies and maintain preserved liver function. However, therapy with SO may require close management to further optimize the clinical outcomes and limit the onset of adverse events (AEs). SO has been in use at our Liver Unit (Avellino, Italy) for over 4 years, and in that time 85 patients with HCC have been treated with SO. Here we describe how patients with HCC are managed with SO in our unit where management is based on three pivotal strategies: targeted patient selection; use of dose escalation to increase compliance and reduce AEs; and adoption of measures to prevent and manage AEs and to provide open access for patients.