Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

The efficacy of transarterial chemoembolization in downstaging unresectable hepatocellular carcinoma to curative therapy: a predicted regression model

Patients with hepatocellular carcinoma (HCC) outside Milan criteria (MC) may be candidates for curative therapy after successful downstaging. We aimed to identify the predictors of successful downstaging of unresectable HCC in patient by transarterial chemoembolization (TACE) outside MC. We performed a retrospective study on patients with unresectable HCC outside MC who received downstaging with TACE. Clinical and laboratory variables were recorded. We identified 101 patients with unresectable HCC who underwent initial TACE, who formed the derivation set of this study. Thirty patients who treated by TACE with the same selection criteria served as an external validation set. We performed univariate and multivariate logistic regression analyses to identify variables associated with successful downstaging. Then we did the predictive model to predict the efficiency of TACE. Of the 101 patients in the study, 26 patients (25.7%) were successfully downstaging and 75 patients (74.3%) failed downstaging. Multivariate analysis of factors to predict successful downstaging of HCC outside MC the number of tumor (P = 0.01), portal vein tumor thrombosis (PVTT)(p < 0.01), the size of tumor (P = 0.02), hepatitis B surface antigen (HBsAg) (P = 0.01), α-fetoprotein (AFP) (P = 0.02) as significant predictors of successful downstaging. Then we constructed the predictive model. The area under the ROC curve (AUROC) of the predictive equation was 0.90 (95% confidence interval, 0.83-0.95). We found in our study that the number and size of tumors, PVTT, HBsAg, and AFP are good predictors of successful downstaging of unresectable HCC in patients by TACE outside the MC.

A prospective clinical trial on sorafenib treatment of hepatocellular carcinoma before liver transplantation

Background

Patients with hepatocellular carcinoma waiting for liver transplantation are commonly treated with locoregional treatments, such as TACE and ablation, to prevent tumor progression and dropout and to improve long-term outcome after transplantation. We wanted to prospectively assess feasibility of systemic antitumor treatment with sorafenib as neoadjuvant treatment for hepatocellular carcinoma while waiting for liver transplantation, evaluating tolerability, toxicity and posttransplant morbidity. We also wanted to evaluate perfusion CT parameters to assess tumor properties and response early after start of sorafenib treatment in patients with early hepatocellular carcinoma.

Methods

Twelve patients assigned for liver transplantation due to hepatocellular carcinoma, within the UCSF and who fulfilled other criteria, were included January 2012–August 2014. After baseline evaluation, sorafenib treatment was started. Treatment was evaluated by perfusion CT at 1, 4 and 12 weeks and thereafter every 8 weeks. Toxicity and quality of life was assessed at 1 and 4 weeks and every 4 weeks thereafter during treatment. Treatment was stopped when patients were prioritized on the transplantation waiting list or when intolerable side effects or tumor progress warranted other treatments. Posttransplant morbidity after 90 days was registered according to Clavien-Dindo.

Results

Baseline perfusion CT parameters in the tumors predicted the outcome according to RECIST/mRECIST at three months, but no change in CTp parameters was detected as a result of sorafenib. Sorafenib as neoadjuvant treatment was associated with intolerability and dose reductions. Therefore the prerequisites for evaluation of the sorafenib effect on both CT parameters and tumor response were impaired.

Conclusions

This study failed to show changes in CTp parameters during sorafenib treatment. Despite the curative treatment intention, tolerability of neoadjuvant sorafenib treatment before liver transplantation was inadequate in this study.

Trial registration

EudraCT number: 2010–024306-36 (date 2011-04-07).

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5760-8) contains supplementary material, which is available to authorized users.

HepG2 and human healthy hepatocyte in vitro culture and co-culture in PCL electrospun platforms

The discovery of new drugs to treat pathological cells in the case of aggressive liver primary cancer is imposing the identification of high-throughput screening systems to predict the in vivo response of new therapeutic molecules, in order to reduce current use of animals and drug testing costs. Recently, micro/nanostructured scaffolds have been adopted to reproduce the hepatic microenvironment due to their higher similarity to the biological niche with respect to the traditional two-dimensional culture plate, so providing novel in vitro models for reliably understanding molecular mechanisms related to cancer cells activity. Herein, we propose the study of electrospun scaffolds made of polycaprolactone as in vitro model that can mimic the morphological organization of native extracellular matrix and the co-culture of hepatic cell lines-i.e., HepG2, human healthy hepatocytes (HHH). The micro- and nano-scale morphological features of fibers with diameter equal to (3.22 ± 0.42) μm and surface roughness of (17.84 ± 4.43) nm-allow the reproduction of the in vivo scenario influencing the adhesion and proliferation rate of the cultured cells. A much lower proliferation rate is observed for the HepG2 cells compared to the HHH cells, when cultured on the fibrous scaffolds over a time course of 4 weeks. Moreover, results on oxidative stress mechanisms indicate an antioxidant effect of fibers mainly in the case of co-colture, thus suggesting a promising use as new in vitro models to explore alternative therapeutic strategies in hepatocarcinoma treatment.