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ABSTRACT

Background No effective systemic therapy exists for patients with advanced hepatocellular carcinoma. A preliminary study suggested that sorafenib, an oral multikinase inhibitor of the vascular endothelial growth factor receptor, the platelet-derived growth factor receptor, and Raf may be effective in hepatocellular carcinoma.

Methods In this multicenter, phase 3, double-blind, placebo-controlled trial, we randomly assigned 602 patients with advanced hepatocellular carcinoma who had not received previous systemic treatment to receive either sorafenib (at a dose of 400 mg twice daily) or placebo. Primary outcomes were overall survival and the time to symptomatic progression. Secondary outcomes included the time to radiologic progression and safety.

Results At the second planned interim analysis, 321 deaths had occurred, and the study was stopped. Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; 95% confidence interval, 0.55 to 0.87; P<0.001). There was no significant difference between the two groups in the median time to symptomatic progression (4.1 months vs. 4.9 months, respectively, P=0.77). The median time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo group (P<0.001). Seven patients in the sorafenib group (2%) and two patients in the placebo group (1%) had a partial response; no patients had a complete response. Diarrhea, weight loss, hand–foot skin reaction, and hypophosphatemia were more frequent in the sorafenib group.

Conclusions In patients with advanced hepatocellular carcinoma, median survival and the time to radiologic progression were nearly 3 months longer for patients treated with sorafenib than for those given placebo. (ClinicalTrials.gov number, NCT00105443 [ClinicalTrials.gov] .)

Source Information

The affiliations of the authors and the names of the investigators in the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) Investigators Study Group are listed in the Appendix.

Address reprint requests to Dr. Llovet or Dr. Bruix at the Barcelona Clínic Liver Cancer Group, Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain, or at jmllovet{at}clinic.ub.es or jbruix{at}clinic.ub.es.

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Related Letters:

Sorafenib in Advanced Hepatocellular Carcinoma
Spinzi G., Paggi S., Copur M. S., Palmer D. H., Llovet J. M., Bruix J., Roberts L. R.
Extract | Full Text | PDF  
N Engl J Med 2008; 359:2497-2499, Dec 4, 2008. Correspondence

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