124IN HEPATOCELLULAR CARCINOMA: PRESENT TREATMENT

Hepatocellular carcinoma (HCC) develops mainly from liver cirrhosis due to hepatitis B or C virus infection. A screening system in patients with cirrhosis is important to diagnose HCC at as earlier a stage as possible. As a result, in Japan, approximately 90 % of HCC patients successfully undergo local therapies including hepatectomy, local ablation, and transcatheter arterial chemoembolization (TACE). However, many patients develop recurrences or progression after these treatments, and an effective systemic therapy is needed to improve the survival. Sorafenib is the first agent which demonstrated survival benefits in patients with unresectable advanced HCC that was approved for HCC in Japan in May, 2009, and more than 13,000 patients have received systemic therapy using sorafenib. In a survey by the Study Group on New Liver Cancer under the auspices of the Health and Labour Sciences Research Grant in Japan, 264 patients treated with sorafenib were analyzed and 90 % of these patients treated with sorafenib received prior treatments including hepatectomy, local ablation and/or TACE. Common adverse events were hand-foot skin reaction, rash and diarrhea. The median overall survival was 11.0 months. These results were comparable with those of a large phase III trial of sorafenib, the SHARP trial. Following sorafenib, several targeted agents are currently under investigation in the treatment of HCC at various stages. Large randomized control trials are needed to establish new standard treatments, and most trials have been conducted in international collaboration including Japan. On the other hand, some trials are conducted only in Japan, for example combination of hepatic arterial infusion chemotherapy with sorafenib. In this presentation, the outcomes of sorafenib treatment in Japan and recent clinical trials in chemotherapy are summarized and discussed. Disclosure: J. Furuse: I received honoraria and consulting fee from Bayer, Eli Lilly