Sorafenib use in elderly patients with hepatocellular carcinoma: caution about use of platelet aggregation inhibitors
Sorafenib use in elderly patients with hepatocellular carcinoma: caution about use of platelet aggregation inhibitors
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DOI：
10.1007/s00280-014-2645-z
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发表时间：
2015-01-01
影响因子：
3
通讯作者：
Boucher, Eveline
中科院分区：
文献类型：
--
作者：
Edeline, Julien;Crouzet, Laurence;Boucher, Eveline
索拉非尼是晚期肝细胞癌（HCC）的标准治疗。HCC的发病高峰期在70岁左右。我们的目的是评估索拉非尼在老年人群中的安全性和有效性。我们回顾性审查了在我们机构接受索拉非尼治疗肝癌的患者的数据。我们比较了不同年龄组的安全性和有效性数据。自2005年以来，129名患者接受了治疗，78名（60.5%）< 70岁，51名（39.5%）为千分之一日元70。两组之间剂量减低的频率相似（48.7 vs. 58.8%），重度毒性的发生率（41.0 vs. 51.0%）和因毒性而住院的发生率（9.0 vs. 13.7%）也相似。然而，虚弱和出血在老年人中更常见。合并抗血小板治疗解释了出血频率较高，PS1老年患者中经常发生严重无力。在年轻组中，治疗中断的频率较低（25.6 vs. 39.2%），由于毒性导致的明确停药的频率显著较低（24.4 vs. 45.1%）。两个年龄组的中位无进展生存期为5.6个月，而中位总生存期在年轻组为9.6个月，在老年组为12.6个月，索拉非尼在老年和年轻肝癌人群中显示出相似的安全性和有效性结果。在老年人群中选择患者时需要进行仔细的基线评估，包括讨论PS1患者的抗血小板治疗停药和谨慎，以及积极管理毒性。
Sorafenib is the standard of care for advanced hepatocellular carcinoma (HCC). The peak incidence of HCC is around 70 years. We aimed to evaluate safety and efficacy of sorafenib in the elderly population.We retrospectively reviewed data from patients treated with sorafenib for HCC at our institution. We compared safety and efficacy data across different age groups.Since 2005, 129 patients were treated, 78 (60.5 %) were < 70 years old and 51 (39.5 %) were a parts per thousand yen70. The frequency of dose reduction was similar between the two groups (48.7 vs. 58.8 %), as was the occurrence of severe toxicities (41.0 vs. 51.0 %) and hospitalization due to toxicity (9.0 vs. 13.7 %). However, asthenia and bleeding were more frequent in the elderly. The higher frequency of bleeding was explained by concomitant antiplatelet treatments, and major asthenia was frequent in PS1 elderly patients. There was a trend toward less frequent interruption of treatment in the younger group (25.6 vs. 39.2 %) and significantly less frequent definitive discontinuation of treatment due to toxicity (24.4 vs. 45.1 %). Median progression-free survival was 5.6 months in both age groups, while median overall survival was 9.6 months in the younger age group and 12.6 months in the older age group.Sorafenib showed similar results in terms of safety and efficacy in the elderly and younger HCC populations. Careful baseline evaluation is needed for patient's selection in the elderly population, including discussion about antiplatelet therapy discontinuation and caution in PS1 patients, as well as active management of toxicity.