Combination of TACE and Sorafenib Improves Outcomes in BCLC Stages B/C of Hepatocellular Carcinoma: A Single Centre Experience

Background and Aim: Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of TACE + sorafenib in BCLC stages B/C. Methods: We performed a retrospective analysis on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival. Results: Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLC-C. Baseline characteristics were comparable in the groups. The predominant etiology of cirrhosis was NASH in both groups (37.2% and 38.5%, P = NS). 49.1% in BCLC-B and 56.9% in BCLC-C had received TACE + sorafenib. In BCLC-B, the overall survival improved from 9months (95%CI 6.3–11.7) using TACE only to 16months (95%CI 12.9–19.1) using TACE + sorafenib (P < 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4months (95%CI 3–5) to 9 months (95%CI 6.8–11.2) (P < 0.0001). As per mRECIST criteria, patients on TACE + sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (P < 0.0001) in BCLC-C but not in BCLC-B group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted. Conclusion: TACE + sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients. The authors have none to declare.