Reduced-Dose Sorafenib Effective and Economical in Hepatocellular Carcinoma
Patients taking a smaller initial dose of sorafenibwere also less likely to discontinue treatment due to gastrointestinal AEs.
Reduced initial sorafenib doses in patients with hepatocellular carcinoma (HCC) may decrease cost of therapy, pill burden, rates of discontinuation due to treatment-related adverse events (AEs), and have a noninferior overall survival (OS) rate compared with the standard dose, according to a study published in The Journal of Clinical Oncology.
For this study, investigators retrospectively assessed 4903 patients with hepatocellular carcinoma who received sorafenib. Sixty-three percent (3094) received the standard starting dose of 800 mg daily and 37% (1809) received reduced doses.
Median overall survival was lower in patients who received sorafenib at a reduced initial dose compared with those who received the standard dose (200 days vs 233 days; hazard ratio [HR], 1.10). However, after propensity score matching and adjusting for potential confounders, no significant difference in OS was observed (adjusted HR, 0.92; 95% CI, 0.83-1.01), which was significantly below the noninferiority margin (P <.001).
The reduced-dose arm was prescribed fewer tablets (median, 180 tablets) compared with the standard-dose arm (276 tablets; P <.001), and had much lower costs ($5636 vs $8661; P <.001).
Patients were also less likely to discontinue treatment due to gastrointestinal AEs (8.7% vs 10.8%; P =.047).
The study authors conclude by saying that the findings “suggest that the initiation of sorafenib at a reduced dosage may be a safe and reasonable strategy for some patients with HCC.”
1. Reiss KA, Yu S, Mamtani R, et al. Starting dose of sorafenib for the treatment of hepatocellular carcinoma: a retrospective, multi-institutional study [published online September 5, 2017]. J Clin Oncol. doi: 10.1200/JCO.2017.73.8245