The best magazine
Abstract and Introduction
Abstract
Background: Sorafenib (Nexavar) is an orally active multikinase inhibitor that is approved for the treatment of hepatocellular carcinoma (HCC). In this study, we used F-2-fluoro-2-deoxyglucose (F-FDG) with positron emission tomography (PET) to predict the treatment outcome of sorafenib in patients with advanced HCC.
Materials and methods: A total of 29 patients with HCC were included. Baseline F-FDG PET scans were performed a median of 14 days before sorafenib treatment. Sorafenib was administered orally at a dose of 400 mg twice daily. For statistical analysis, the standardized uptake value (SUV) of the most hypermetabolic lesion was obtained and assigned as the SUVmax for each patient.
Results: Among 29 patients, one patient achieved partial remission and 14 patients showed stable disease. The overall survival (OS) and progression free survival (PFS) were 5.1 months [95% confidence interval (CI): 0.0–12.0] and 3.8 months (95% CI: 1.4–6.2). The multivariate analysis of OS showed that four indices, Eastern Cooperative Oncology Group performance status, α-fetoprotein (AFP) concentration, portal vein thrombosis and SUVmax were significant prognostic factors (P=0.030, P=0.024, P=0.020 and P=0.015 respectively). AFP concentration and SUVmax were independent prognostic factors for PFS, too (P=0.003 and P=0.026 respectively). When the patients were divided into two groups: low SUVmax (n=10; <5.00) and high SUVmax (n=19;≥5.00), the low SUV group showed significantly longer OS and PFS (P=0.023 and P=0.042 respectively).
Conclusion: Our study showed that the degree of FDG uptake is an independent prognostic factor in patients with HCC who undergo sorafenib treatment.
Introduction
Hepatocellular carcinoma (HCC) is a major health problem, with 626 000 new cases per year worldwide. The incidence of HCC is increasing in the United States and Europe, and it is the third highest cause of cancer-related death globally, behind only lung and stomach cancers. Only 30–40% of patients are amenable to potentially curative treatments. For patients with advanced stage HCC or with disease progression after locoregional therapy, treatment options are very limited. Conventional cytotoxic chemotherapy, hormonal therapy and immunotherapy, does not improve survival outcomes in advanced HCC patients, and no drug or regimen has been approved as standard treatment for HCC.
Recently, advances in the understanding of hepatocarcinogenesis with newly developed molecularly targeted agents have led to new options for treatment of this chemoresistant tumour. Sorafenib is an oral multikinase inhibitor with antiproliferative and anti-angiogenic effects that target the Raf/MAPK/ERK signalling pathway and the tyrosine kinase VEGFR-2 and -3 and PDGF receptors.
Two pivotal phase III studies have demonstrated survival benefit of sorafenib for advanced HCC. Therefore, sorafenib became the new reference standard systemic therapy for advanced HCC. However, there are many unsolved issues in the practice setting. Tyrosine kinase inhibitors are costly and have moderate side effects, so it is important to select the optimal candidates for treatment, as well as monitor the treatment response.
F-2-fluoro-2-deoxyglucose (F-FDG) with positron emission tomography (PET) has emerged in recent years, and is widely used for baseline staging and treatment response monitoring in HCC. As F-FDG PET assesses the glucose metabolic activity of tumours, it provides useful information that cannot be obtained with other conventional imaging techniques. For HCC, recent studies in liver tumours have shown that F-FDG PET is useful for tumour characterization, prognosis prediction and assessment of therapeutic response.
In this study, we investigated the usefulness of F-FDG PET scan for predicting the outcome of sorafenib treatment in patients with advanced HCC.
Source: ...