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- Title
Impact of age on sorafenib outcomes in hepatocellular carcinoma: an international cohort study.
- Authors
Hajiev, Saur; Allara, Elias; Motedayеn Aval, Leila; Arizumi, Tadaaki; Bettinger, Dominik; Pirisi, Mario; Rimassa, Lorenza; Pressiani, Tiziana; Personeni, Nicola; Giordano, Laura; Kudo, Masatoshi; Thimme, Robert; Park, Joong-Won; Taddei, Tamar H.; Kaplan, David E.; Ramaswami, Ramya; Pinato, David J.; Sharma, Rohini
- Abstract
<bold>Background: </bold>There is no consensus on the effect of sorafenib dosing on efficacy and toxicity in elderly patients with hepatocellular carcinoma (HCC). Older patients are often empirically started on low-dose therapy with the aim to avoid toxicities while maximising clinical efficacy. We aimed to verify whether age impacts on overall survival (OS) and whether a reduced starting dose impacts on OS or toxicity experienced by the elderly.<bold>Methods: </bold>In an international, multicentre cohort study, outcomes for those aged <75 or ≥75 years were determined while accounting for common prognostic factors and demographic characteristics in univariable and multivariable models.<bold>Results: </bold>Five thousand five hundred and ninety-eight patients were recruited; 792 (14.1%) were aged ≥75 years. The elderly were more likely to have larger tumours (>7 cm) (39 vs 33%, p < 0.01) with preserved liver function (67 vs 57.7%) (p < 0.01). No difference in the median OS of those aged ≥75 years and <75 was noted (7.3 months vs 7.2 months; HR 1.00 (95% CI 0.93-1.08), p = 0.97). There was no relationship between starting dose of sorafenib 800 mg vs 400 mg/200 mg and OS between those <75 and ≥75 years. The elderly experienced a similar overall incidence of grade 2-4 sorafenib-related toxicity compared to <75 years (63.5 vs 56.7%, p = 0.11). However, the elderly were more likely to discontinue sorafenib due to toxicity (27.0 vs 21.6%, p < 0.01). This did not vary between different starting doses of sorafenib.<bold>Conclusions: </bold>Clinical outcomes in the elderly is equivalent to patients aged <75 years, independent of dose of sorafenib prescribed.
- Subjects
RESEARCH; LIVER tumors; AGE distribution; RESEARCH methodology; ANTINEOPLASTIC agents; PROGNOSIS; MEDICAL cooperation; EVALUATION research; TREATMENT effectiveness; COMPARATIVE studies; DOSE-effect relationship in pharmacology; HEPATOCELLULAR carcinoma; LONGITUDINAL method
- Publication
British Journal of Cancer, 2021, Vol 124, Issue 2, p407
- ISSN
0007-0920
- Publication type
journal article
- DOI
10.1038/s41416-020-01116-9