Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience
Background. Hepatocellular carcinoma (HCC) has a rising incidence and mortality in North America. Liver transplantation (LT) with adjunctive therapies offers excellent outcomes. However, HCC recurrences are associated with high mortality. We investigate whether adjuvant systemic therapy can reduce r...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2025-02-01
|
| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001746 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832589610888200192 |
|---|---|
| author | Hala Hassanain, MD Ashton A. Connor, MD, PhD Elizabeth W. Brombosz, PhD Khush Patel, MD, MS Ahmed Elaileh, MD Tamneet Basra, MD Sudha Kodali, MD, MSPH David W. Victor, III, MD Caroline J. Simon, MD Yee Lee Cheah, MD Mark J. Hobeika, MD Constance M. Mobley, MD, PhD Ashish Saharia, MD Sadhna Dhingra, MD Mary Schwartz, MD Anaum Maqsood, MD Kirk Heyne, MD Ahmed O. Kaseb, MD Jean-Nicolas Vauthey, MD A. Osama Gaber, MD Maen Abdelrahim, MD, PhD R. Mark Ghobrial, MD, PhD |
| author_facet | Hala Hassanain, MD Ashton A. Connor, MD, PhD Elizabeth W. Brombosz, PhD Khush Patel, MD, MS Ahmed Elaileh, MD Tamneet Basra, MD Sudha Kodali, MD, MSPH David W. Victor, III, MD Caroline J. Simon, MD Yee Lee Cheah, MD Mark J. Hobeika, MD Constance M. Mobley, MD, PhD Ashish Saharia, MD Sadhna Dhingra, MD Mary Schwartz, MD Anaum Maqsood, MD Kirk Heyne, MD Ahmed O. Kaseb, MD Jean-Nicolas Vauthey, MD A. Osama Gaber, MD Maen Abdelrahim, MD, PhD R. Mark Ghobrial, MD, PhD |
| author_sort | Hala Hassanain, MD |
| collection | DOAJ |
| description | Background. Hepatocellular carcinoma (HCC) has a rising incidence and mortality in North America. Liver transplantation (LT) with adjunctive therapies offers excellent outcomes. However, HCC recurrences are associated with high mortality. We investigate whether adjuvant systemic therapy can reduce recurrence, as shown with other malignancies.
Methods. Medical records of patients undergoing LT for HCC at a single center between January 2016 and December 2022 were retrospectively reviewed. Patients were stratified into 3 groups: (1) recipients of adjuvant sorafenib, (2) nonrecipients at high recurrence risk, and (3) nonrecipients at low risk by explant pathology features. The outcomes were overall survival (OS) and recurrence-free survival (RFS). Adjuvant sorafenib recipients were also propensity score matched 1:2 to nonadjuvant recipients based on recurrence risk features.
Results. During the study period, 273 patients with HCC underwent LT and 16 (5.9%) received adjuvant sorafenib therapy. Adjuvant sorafenib recipients were demographically similar to nonrecipients and, on explant pathology, had greater tumor burden, lymphovascular invasion, and poorer differentiation (all P < 0.001). Adverse events were observed in 12 adjuvant sorafenib recipients (75%). OS was similar among the 3 groups (P = 0.2), and adjuvant sorafenib was not associated with OS in multivariable analysis (hazard ratio, 1.31; 95% confidence interval, 0.45-3.78; P = 0.62). RFS was significantly lower in sorafenib patients (hazard ratio, 6.99; 95% confidence interval, 2.12-23.05; P = 0.001). Following propensity matching, adjuvant sorafenib use was not associated with either OS (P = 0.24) or RFS rates (P = 0.65).
Conclusions. In this single-center analysis, adjuvant sorafenib was not associated with OS. Recipients were observed to have shorter RFS, likely due to the increased prevalence of high-risk features, and sorafenib use was associated with high frequencies of adverse events. |
| format | Article |
| id | doaj-art-20f078b8e5da45468e958c325bb47621 |
| institution | Kabale University |
| issn | 2373-8731 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj-art-20f078b8e5da45468e958c325bb476212025-01-24T09:21:00ZengWolters KluwerTransplantation Direct2373-87312025-02-01112e174610.1097/TXD.0000000000001746202502000-00007Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center ExperienceHala Hassanain, MD0Ashton A. Connor, MD, PhD1Elizabeth W. Brombosz, PhD2Khush Patel, MD, MS3Ahmed Elaileh, MD4Tamneet Basra, MD5Sudha Kodali, MD, MSPH6David W. Victor, III, MD7Caroline J. Simon, MD8Yee Lee Cheah, MD9Mark J. Hobeika, MD10Constance M. Mobley, MD, PhD11Ashish Saharia, MD12Sadhna Dhingra, MD13Mary Schwartz, MD14Anaum Maqsood, MD15Kirk Heyne, MD16Ahmed O. Kaseb, MD17Jean-Nicolas Vauthey, MD18A. Osama Gaber, MD19Maen Abdelrahim, MD, PhD20R. Mark Ghobrial, MD, PhD211 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA2 Department of Medicine, Houston Methodist Hospital, Houston, TX, USA2 Department of Medicine, Houston Methodist Hospital, Houston, TX, USA2 Department of Medicine, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA3 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA3 Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA4 Dr. Mary and Ron Neal Cancer Center, Department of Medicine, Houston Methodist Hospital, Houston, TX4 Dr. Mary and Ron Neal Cancer Center, Department of Medicine, Houston Methodist Hospital, Houston, TX5 Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX6 Department of Surgical Oncology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA4 Dr. Mary and Ron Neal Cancer Center, Department of Medicine, Houston Methodist Hospital, Houston, TX1 Department of Surgery, Houston Methodist Hospital, Houston, TX, USABackground. Hepatocellular carcinoma (HCC) has a rising incidence and mortality in North America. Liver transplantation (LT) with adjunctive therapies offers excellent outcomes. However, HCC recurrences are associated with high mortality. We investigate whether adjuvant systemic therapy can reduce recurrence, as shown with other malignancies. Methods. Medical records of patients undergoing LT for HCC at a single center between January 2016 and December 2022 were retrospectively reviewed. Patients were stratified into 3 groups: (1) recipients of adjuvant sorafenib, (2) nonrecipients at high recurrence risk, and (3) nonrecipients at low risk by explant pathology features. The outcomes were overall survival (OS) and recurrence-free survival (RFS). Adjuvant sorafenib recipients were also propensity score matched 1:2 to nonadjuvant recipients based on recurrence risk features. Results. During the study period, 273 patients with HCC underwent LT and 16 (5.9%) received adjuvant sorafenib therapy. Adjuvant sorafenib recipients were demographically similar to nonrecipients and, on explant pathology, had greater tumor burden, lymphovascular invasion, and poorer differentiation (all P < 0.001). Adverse events were observed in 12 adjuvant sorafenib recipients (75%). OS was similar among the 3 groups (P = 0.2), and adjuvant sorafenib was not associated with OS in multivariable analysis (hazard ratio, 1.31; 95% confidence interval, 0.45-3.78; P = 0.62). RFS was significantly lower in sorafenib patients (hazard ratio, 6.99; 95% confidence interval, 2.12-23.05; P = 0.001). Following propensity matching, adjuvant sorafenib use was not associated with either OS (P = 0.24) or RFS rates (P = 0.65). Conclusions. In this single-center analysis, adjuvant sorafenib was not associated with OS. Recipients were observed to have shorter RFS, likely due to the increased prevalence of high-risk features, and sorafenib use was associated with high frequencies of adverse events.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001746 |
| spellingShingle | Hala Hassanain, MD Ashton A. Connor, MD, PhD Elizabeth W. Brombosz, PhD Khush Patel, MD, MS Ahmed Elaileh, MD Tamneet Basra, MD Sudha Kodali, MD, MSPH David W. Victor, III, MD Caroline J. Simon, MD Yee Lee Cheah, MD Mark J. Hobeika, MD Constance M. Mobley, MD, PhD Ashish Saharia, MD Sadhna Dhingra, MD Mary Schwartz, MD Anaum Maqsood, MD Kirk Heyne, MD Ahmed O. Kaseb, MD Jean-Nicolas Vauthey, MD A. Osama Gaber, MD Maen Abdelrahim, MD, PhD R. Mark Ghobrial, MD, PhD Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience Transplantation Direct |
| title | Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience |
| title_full | Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience |
| title_fullStr | Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience |
| title_full_unstemmed | Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience |
| title_short | Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience |
| title_sort | sorafenib as adjuvant therapy post liver transplant a single center experience |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001746 |
| work_keys_str_mv | AT halahassanainmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT ashtonaconnormdphd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT elizabethwbromboszphd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT khushpatelmdms sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT ahmedelailehmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT tamneetbasramd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT sudhakodalimdmsph sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT davidwvictoriiimd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT carolinejsimonmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT yeeleecheahmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT markjhobeikamd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT constancemmobleymdphd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT ashishsahariamd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT sadhnadhingramd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT maryschwartzmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT anaummaqsoodmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT kirkheynemd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT ahmedokasebmd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT jeannicolasvautheymd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT aosamagabermd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT maenabdelrahimmdphd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience AT rmarkghobrialmdphd sorafenibasadjuvanttherapypostlivertransplantasinglecenterexperience |