Impact of age on sorafenib outcomes in hepatocellular carcinoma: an international cohort study

Saur Hajiev, Elias Allara, Leila Motedayеn Aval, Tadaaki Arizumi, Dominik Bettinger, Mario Pirisi, Lorenza Rimassa, Tiziana Pressiani, Nicola Personeni, Laura Giordano, Masatoshi Kudo, Robert Thimme, Joong-Won Park, Tamar H Taddei, David E Kaplan, Ramya Ramaswami, David J Pinato, Rohini Sharma

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: Clinical outcomes in the elderly is equivalent to patients aged <75 years, independent of dose of sorafenib prescribed.

Original languageEnglish
Pages (from-to)407-413
Number of pages7
JournalBritish Journal of Cancer
Volume124
Issue number2
DOIs
Publication statusPublished - Jan 2021

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