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Wong JSL, Dong Y, Tang V, Leung T, Yeung CSY, Tai A, Law A, Shum T, Kwok GGW, Li BCW, Leung R, Chiu J, Ma KW, She WH, Tsang J, Cheung TT, Yau T. The Use of Cabozantinib in Advanced Hepatocellular Carcinoma in Hong Kong-A Territory-Wide Cohort Study. Cancers (Basel) 2021; 13:2002. [PMID: 33919277 PMCID: PMC8122581 DOI: 10.3390/cancers13092002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Cabozantinib is approved in sorafenib-exposed advanced hepatocellular carcinoma (aHCC). We evaluated the real-life pattern of use, efficacy, and tolerability of cabozantinib in aHCC. (2) Methods: This territory-wide study included consecutive aHCC patients who received cabozantinib between February 2018 and September 2020 in Hong Kong. The objective response rate (ORR), disease control rate (DCR), overall survival (OS), and adverse events (AE) were assessed. (3) Results: Overall, 42 patients were included. Approximately 83.3% had Child-Pugh A cirrhosis. About 64.3% received cabozantinib as a single agent, and the remaining 35.7% received cabozantinib as an add-on to immune checkpoint inhibitors (ICIs). For single-agent patients, the median follow-up was 6.7 months. The ORR was 3.7%, DCR was 44.4%, and the median OS was 8.28 months. About 74.1% of patients experienced any AEs with 7.4% having grade ≥3 AEs. Among patients who received prior ICIs (n = 16), the ORR was 6.3%, and the median OS was 8.28 months. An exploratory analysis of patients who received cabozantinib as an add-on to ICIs showed an ORR of 6.7% and a median OS of 15.1 months, with 73.3% having any AE and 13.3% having grade ≥3 AEs. (4) Conclusions: Cabozantinib had good anti-tumor activity, survival benefits, and acceptable tolerability in real-life aHCC patients.
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Affiliation(s)
- Jeffrey Sum-Lung Wong
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Yawen Dong
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Vikki Tang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Thomas Leung
- Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China;
| | | | - Anna Tai
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China;
| | - Ada Law
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China;
| | - Tracy Shum
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China;
| | - Gerry Gin-Wai Kwok
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Bryan Cho-Wing Li
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Roland Leung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Joanne Chiu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Ka-Wing Ma
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (K.W.-M.); (W.H.-S.); (T.T.-C.)
| | - Wong-Hoi She
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (K.W.-M.); (W.H.-S.); (T.T.-C.)
| | - Josephine Tsang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (K.W.-M.); (W.H.-S.); (T.T.-C.)
| | - Thomas Yau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; (J.S.-L.W.); (Y.D.); (V.T.); (G.G.-W.K.); (B.C.-W.L.); (R.L.); (J.C.); (J.T.)
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Ho CHM, Chiang CL, Lee FAS, Chan JCH, Yeung CSY, Choi CKK, Wong FCS, Tung SY. Albumin-bilirubin versus Child-Pugh Grade as a Predictor of Survival after Individualised Hypofractionated Radiotherapy for Hepatocellular Carcinoma. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2016971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - JCH Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CKK Choi
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - SY Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Wong NSM, Chiang CL, Ho CHM, Yip WWL, Yeung CSY, Chan MKH, Lee VWY, Lee FAS, Wong FCS. Prognostic Factors and Survival in Advanced Large Hepatocellular Carcinomas Treated with Combined Transarterial Chemoembolisation and Hypofractionated Image-guided Radiotherapy. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- NSM Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - WWL Yip
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - MKH Chan
- Department of Radiation Physics, University Hospital Essen, Germany
| | - VWY Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Yeung CSY, Chiang CL, Wong NSM, Ha SK, Tsang KS, Ho CHM, Wang B, Lee VWY, Chan MKH, Lee FAS. Palliative Liver Radiotherapy (RT) for Symptomatic Hepatocellular Carcinoma (HCC). Sci Rep 2020; 10:1254. [PMID: 31988376 PMCID: PMC6985173 DOI: 10.1038/s41598-020-58108-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
This study aims at evaluating the symptom response, response duration, and toxicity of single dose palliative liver radiotherapy (RT) for symptomatic HCC patients. We reviewed unresectable HCC patients treated with palliative RT in our institution. Eligible patients were unsuitable or refractory to trans-arterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT), with an index symptom of pain or abdominal discomfort. The primary outcome was the percentage of patients with clinical improvement of index symptom at 1 month. Secondary outcomes were response duration, toxicities, alpha-feto protein (AFP) response, and radiological response. Fifty-two patients were included in the study. The index symptom was pain in 34 patients (65.4%), and abdominal discomfort (34.6%) in 18 patients. At 1 month, 51.9% of patients had improvement of symptoms. Median time to symptom progression was 89 days (range: 12–392 days). Treatment was well tolerated with only 2 patients (3.8%) developing grade 3 GI toxicities. AFP response, radiological response rate, and disease control rate at 3 months were 48.6%, 15.1%, and 54.5% respectively. Half of the patients had improvement of index symptoms after receiving palliative liver RT with median response duration of 3 months. The treatment was well tolerated with minimal toxicities.
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Affiliation(s)
- Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China. .,Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China. .,Department of Clinical Oncology, HKU-Shenzhen Hospital, ShenZhen, China.
| | - Natalie S M Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - S K Ha
- Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China
| | - K S Tsang
- Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - B Wang
- Department of Clinical Oncology, HKU-Shenzhen Hospital, ShenZhen, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - Mark K H Chan
- Department of Radiation Physics, Imperial College London NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
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Chiang CL, Chan MKH, Yeung CSY, Ho CHM, Lee FAS, Lee VWY, Wong FCS, Blanck O. Combined stereotactic body radiotherapy and trans-arterial chemoembolization as initial treatment in BCLC stage B-C hepatocellular carcinoma. Strahlenther Onkol 2018; 195:254-264. [PMID: 30413833 DOI: 10.1007/s00066-018-1391-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/17/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE We retrospectively evaluated the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with trans-arterial chemoembolization (TACE) as initial therapy in Barcelona Clinic Liver Cancer (BCLC) system stage B-C hepatocellular carcinoma (HCC). PATIENTS AND METHODS Seventy-two patients received a single dose of TACE followed by SBRT 4 weeks later. All patients had tumor sizes ≥5 cm, at least 700 ml of disease-free liver, Child-Pugh (CP) score ≤ B7 and tumor nodules ≤5. SBRT dose, ranging from 6 × 5-8 Gy or 5-10 × 4 Gy, was individualized according to normal tissue constraints. No subsequent scheduled treatment was delivered unless disease progression was observed. Local control (LC), overall survival (OS), progression-free survival (PFS), response rate (RR), and toxicity were evaluated. RESULTS The patients' characteristics were: median age 60 years (range 28-87 years); CP score A/B (n = 68/4); BCLC stage B/C (n = 51/21); solitary/multifocal (n = 37/35); portal vein invasion (n = 18). The median tumor size and GTV were 11.2 cm (range 5.0-23.6 cm) and 751 cm3 (range 41-4009 cm3), respectively. The median equivalent dose in 2 Gy per fraction (EQD2, α/β = 10) was 37.3 Gy2 (range, 28-72 Gy2). The median follow-up time was 16.8 months (range, 3-96 months). The objective RR was 68% and the 1‑year LC rate was 93.6% (95% CI, 87.6-100%). The median OS was 19.8 months (95% CI, 11.6-30.6 months). SBRT-related grade 3 or higher adverse gastrointestinal events and treatment-related death occurred in three (2.8%) and one patient (1.4%) respectively. No patient developed classical radiation-induced liver injury. CONCLUSION Our experience suggests that combined TACE and SBRT can be a safe and effective initial therapy for BCLC stage B-C HCC with appropriate patient selection. Further prospective trials are warranted.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Mark K H Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China. .,Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany.
| | - Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Oliver Blanck
- Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
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Ho CHM, Chiang CL, Lee FAS, Choi HCW, Chan JCH, Yeung CSY, Huang JJ, Chan MKH, Blanck O, Wong FCS. Comparison of platelet-albumin-bilirubin (PALBI), albumin-bilirubin (ALBI), and child-pugh (CP) score for predicting of survival in advanced hcc patients receiving radiotherapy (RT). Oncotarget 2018; 9:28818-28829. [PMID: 29988960 PMCID: PMC6034750 DOI: 10.18632/oncotarget.25522] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/12/2018] [Indexed: 01/27/2023] Open
Abstract
Purpose This work evaluated the prognostic performance of Child-Pugh (CP), albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) scores in hepatocellular carcinoma (HCC) patients undergoing radiotherapy (RT). Results The study included 174 consecutive patients with 63% at CP A5 (n = 110) and 34% at CP A6 (n = 64). The median ALBI score was −2.39 (range: −3.61 to −1.41) with 34.5% at grade A1 (n = 60) and 65.5% at grade A2 (n = 114). The median PALBI score was −2.39 (range −3.39 to −1.24) with 33.3% at grade 1 (n = 58), 41.4% at grade 2 (n = 72) and 25.3% at grade 3 (n = 44). With a median follow-up of 21.7 months, the median OS of the entire cohort was 22.2 months. OS was significantly associated with the PALBI grade (p = 0.002) and for the ALBI grade (p = 0.00495), but not for the CP score (p = 0.46). The PALBI grade has a significantly higher AUC compared than the ALBI grade or CP scores in predicting OS. The PALBI grade was predictive of CP score decline ≥2 (20% grade 3 vs. 5.3% grade 1/2 p = 0.05) but the ALBI and CP scores were not. Conclusion Among CP A HCC patients receiving radiotherapy, the PALBI and ALBI grade maybe a better prognostic tool than the CP score. The role of PALBI in predicting liver toxicity warranted further exploration. Methods We retrospectively reviewed HCC patients treated with individualized hypo-fractionated radiotherapy (IHRT) using stereotactic technique from 2006 to 2015. We collected CP, ALBI and PALBI scores prior to treatment and analyzed their correlation with overall survival (OS) and liver toxicity.
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Affiliation(s)
- Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China
| | - Chi-Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China.,Department of Clinical Oncology, University of Hong Kong, Hong Kong (SAR), China.,University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China
| | - Horace C W Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong (SAR), China
| | - Jeffery C H Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong (SAR), China
| | - Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China
| | - J J Huang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China
| | - Mark K H Chan
- Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany.,Department of Radiation Physics, Imperial College NHS Healthcare, Charing Cross Hospital, UK, London
| | - Oliver Blanck
- Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China
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Chiang CL, Yeung CSY, Wong MYP, Lee VWY, Lee VHF, Lee FAS, Wong FCS. Stereotactic Body Radiotherapy for Pancreatic Cancer. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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