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Carballo-Folgoso L, Álvarez-Velasco R, Lorca R, Castaño-García A, Cuevas J, González-Diéguez ML, Martín M, Álvarez-Navascués C, Cadahía V, Morís C, Rodríguez M, Varela M. Evaluation of cardiovascular events in patients with hepatocellular carcinoma treated with sorafenib in the clinical practice. The CARDIO-SOR study. Liver Int 2021; 41:2200-2211. [PMID: 33966333 DOI: 10.1111/liv.14941] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/31/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The effectiveness of systemic treatment in advanced hepatocellular carcinoma (HCC) depends on the selection of patients, management of cirrhosis complications and expertise to treat adverse events. The aims of the study are to assess the frequency and management of cardiovascular events in HCC patients treated with sorafenib (SOR) and to create a scale to predict the onset of major adverse cardiovascular events (MACE). METHOD Observational retrospective study with consecutive HCC patients treated with SOR between 2007 and 2019 in a western centre. In order to classify cardiovascular risk pre-SOR, we designed the CARDIOSOR scale with age, hypertension, diabetes, dyslipidaemia and peripheral vascular disease. Other adverse events, dosing and outcome data were collected during a homogeneous protocolled follow-up. RESULTS Two hundred ninety-nine patients were included (219 BCLC-C). The median overall survival was 11.1 months (IQR 5.6-20.5), and duration of treatment was 7.4 months (IQR 3.3-14.7). Seventeen patients (6%) stopped SOR due to cardiovascular event. Thirty-three patients suffered MACE (7 heart failure, 11 acute coronary syndrome, 12 cerebrovascular accident and 8 peripheral vascular ischemia); 99 had a minor cardiovascular event, mainly hypertension (n = 81). Age was the only independent factor associated to MACE (HR 1.07; 95% CI 1.03-1.12; P = .002). The CARDIOSOR scale allows to identify the group of patients with higher risk of MACE (sHR 3.4; 95% CI 1.4-6.7; P = .04). CONCLUSION The incidence of cardiovascular events in HCC patients treated with SOR is higher than expected. Multidisciplinary approach and clinical tools like CARDIOSOR scale could be helpful to manage these patients.
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Affiliation(s)
- Lorena Carballo-Folgoso
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rut Álvarez-Velasco
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rebeca Lorca
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain.,ISPA, Oviedo, Spain
| | - Andrés Castaño-García
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Cuevas
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María Luisa González-Diéguez
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María Martín
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen Álvarez-Navascués
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Valle Cadahía
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - César Morís
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain.,ISPA, Oviedo, Spain.,Department of Medicine, Universidad de Oviedo, Oviedo, Spain
| | - Manuel Rodríguez
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain.,ISPA, Oviedo, Spain.,Department of Medicine, Universidad de Oviedo, Oviedo, Spain
| | - María Varela
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain.,ISPA, Oviedo, Spain.,Department of Medicine, Universidad de Oviedo, Oviedo, Spain.,IUOPA, Oviedo, Spain
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Colombatto P, Demirtas CO, Ricco G, Civitano L, Boraschi P, Scalise P, Cavallone D, Oliveri F, Romagnoli V, Bleve P, Coco B, Salvati A, Urbani L, Bonino F, Brunetto MR. Modeling Hepatocellular Carcinoma Cells Dynamics by Serological and Imaging Biomarkers to Explain the Different Responses to Sorafenib and Regorafenib. Cancers (Basel) 2021; 13:2064. [PMID: 33922938 PMCID: PMC8123288 DOI: 10.3390/cancers13092064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
In advanced HCC, tyrosine-kinase inhibitors obtain partial responses (PR) in some patients and complete responses (CR) in a few. Better understanding of the mechanism of response could be achieved by the radiomic approach combining digital imaging and serological biomarkers (α-fetoprotein, AFP and protein induced by vitamin K absence-II, PIVKA-II) kinetics. A physic-mathematical model was developed to investigate cancer cells and vasculature dynamics in three prototype patients receiving sorafenib and/or regorafenib and applied in seven others for validation. Overall four patients showed CR, two PR, two stable-disease (SD) and two progressive-disease (PD). The rate constant of cancer cells production was higher in PD than in PR-SD and CR (median: 0.398 vs. 0.325 vs. 0.316 C × day-1). Therapy induced reduction of neo-angiogenesis was greater in CR than in PR-SD and PD (median: 83.2% vs. 29.4% and 2.0%), as the reduction of cell-proliferation (55.2% vs. 7.6% and 0.7%). An additional dose-dependent acceleration of tumor vasculature decay was also observed in CR. AFP and cancer cells followed the same kinetics, whereas PIVKA-II time/dose dependent fluctuations were influenced also by tissue ischemia. In conclusion, pending confirmation in a larger HCC cohort, modeling serological and imaging biomarkers could be a new tool for systemic therapy personalization.
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Affiliation(s)
- Piero Colombatto
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | | | - Gabriele Ricco
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Luigi Civitano
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Piero Boraschi
- Radiodiagnostic Unit, Pisa University Hospital, 56124 Pisa, Italy; (P.B.); (P.S.)
| | - Paola Scalise
- Radiodiagnostic Unit, Pisa University Hospital, 56124 Pisa, Italy; (P.B.); (P.S.)
| | - Daniela Cavallone
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
- Department of Clinical and Experimental Medicine, Pisa University, 56124 Pisa, Italy
| | - Filippo Oliveri
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Veronica Romagnoli
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Patrizia Bleve
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Barbara Coco
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Antonio Salvati
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
| | - Lucio Urbani
- General Surgery Unit, Pisa University Hospital, 56124 Pisa, Italy;
| | - Ferruccio Bonino
- Biostructure and Bio-Imaging Institute of National Research Council of Italy, 56124 Pisa, Italy;
| | - Maurizia Rossana Brunetto
- Hepatology Unit, Pisa University Hospital, 56124 Pisa, Italy; (G.R.); (L.C.); (D.C.); (F.O.); (V.R.); (P.B.); (B.C.); (A.S.)
- Department of Clinical and Experimental Medicine, Pisa University, 56124 Pisa, Italy
- General Surgery Unit, Pisa University Hospital, 56124 Pisa, Italy;
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