Details

Autor(en) / Beteiligte

• Pinato, D. J.
• Yen, C.
• Bettinger, D.
• Ramaswami, R.
• Arizumi, T.
• Ward, C.
• Pirisi, M.
• Burlone, M. E.
• Thimme, R.
• Kudo, M.
• Sharma, R.

Titel

The albumin–bilirubin grade improves hepatic reserve estimation post‐sorafenib failure: implications for drug development

Ist Teil von

• Alimentary pharmacology & therapeutics, 2017-03, Vol.45 (5), p.714-722

Ort / Verlag

England: Wiley Subscription Services, Inc

Erscheinungsjahr

2017

Quelle

Wiley Online Library - AutoHoldings Journals

Beschreibungen/Notizen

• Summary Background Drug development in hepatocellular carcinoma (HCC) is limited by disease heterogeneity, with hepatic reserve being a major source of variation in survival outcomes. The albumin–bilirubin (ALBI) grade is a validated index of liver function in patients with HCC. Aim To test the accuracy of the ALBI grade in predicting post‐sorafenib overall survival (PSOS) in patients who permanently discontinued treatment. Methods From a prospectively maintained international database of 447 consecutive referrals, we derived 386 eligible patients treated with sorafenib within Barcelona Clinic Liver Cancer C stage (62%), 75% of whom were of Child class A at initiation. Clinical variables at sorafenib discontinuation were analysed for their impact on post‐sorafenib overall survival using uni‐ and multivariable analyses. Results Median post‐sorafenib overall survival of the 386 eligible patients was 3.4 months and median sorafenib duration was 2.9 months, with commonest causes of cessation being disease progression (68%) and toxicity (24%). At discontinuation, 92 patients (24%) progressed to terminal stage, due to worsening Child class to C in 40 (10%). Median post‐sorafenib overall survival in patients eligible for second‐line therapies (n = 294) was 17.5, 7.5 and 1.9 months according respectively to ALBI grade 1, 2 and 3 (P < 0.001). Conclusions The ALBI grade at sorafenib discontinuation identifies a subset of patients with prolonged stability of hepatic reserve and superior survival. This may allow improved patient selection for second‐line therapies in advanced HCC.