Efficacy of apatinib in patients with sorafenib-transarterial chemoembolization refractory hepatocellular carcinoma: a retrospective study

Purpose: To investigate the efficacy of sequential apatinib treatment in patients with unresectable hepatocellular carcinoma (HCC) refractory to sorafenib-transarterial chemoembolization (TACE).

Materials and methods: This respective study was conducted on 95 consecutive patients with sorafenib-TACE-refractory unresectable HCC in our center from January 2014 to December 2019. According to the response to sorafenib-TACE treatment and the subsequent management, the eligible patients were assigned into three groups: sorafenib-TACE (ST) group, sorafenib-TACE-apatinib (STA) group, and sorafenib-TACE-supportive care (STS) group. The differences in overall survival (OS) and tumor response were compared among the three groups. Risk factors related to prognosis were analyzed.

Results: A total of 58 patients were enrolled in the study, with 11, 15, and 28 patients in ST, STA, and STS group, respectively. The median OS of the STA group was significantly improved when compared with the STS group, either from the start of sorafenib-TACE resistance or the initiation of sorafenib-TACE therapy (14.0 versus 4.0 months, p = 0.003; 19.0 versus 9.0 months, p < 0.001; respectively). Additionally, from the start of sorafenib-TACE treatment, the median OS of the STA group was longer than that of the ST group without statistical difference (19.0 versus 15.0 months, p = 0.28), so did the comparison of median OS between the ST group and the STS group (15.0 versus 9.0 months, p = 0.06). Extrahepatic metastases were an independent risk factor for poor prognosis.

Conclusion: In patients with sorafenib-TACE-refractory HCC, subsequent apatinib treatment significantly improved the OS when compared with supportive care, and produced comparative outcomes with those sorafenib-TACE responders.