Treatment of Hepatocellular Carcinoma with Sorafenib – Focus on Special Populations and Adverse Event Management

Abstract

Sorafenib, a receptor tyrosine kinase-inhibitor with anti-proliferative and anti-angiogenic activity, is currently the only approved systemic treatment for patients with hepatocellular carcinoma. It inhibits downstream signaling of VEGFR-2, PDGFR, c-Kit receptors and BRAF. Over the last four years comprehensive experience with sorafenib in this indication has been accumulated. In this review we discuss the current data on the use of sorafenib in patients with advanced HCC including special patient populations such as patients with impaired liver function, patients after transplantation, and others. The most frequent side-effects and practical tips on how to manage them are discussed in detail. In addition, we summarize the current experimental data on the use of sorafenib in combination treatment, e. g., together with transarterial chemoembolisation or other targeted agents.

Zusammenfassung

Sorafenib, ein Tyrosinkinaseinhibitor mit antiproliferativer und antiangiogenetischer Wirkung, ist derzeit die einzige zugelassene Substanz in der Therapie von Patienten mit fortgeschrittenem hepatozellulären Karzinom. Es hemmt multiple Rezeptortyrosinkinasen, einschließlich dem VEGFR-2, dem PDGFR, dem c-Kit-Rezeptor und B-RAF. In den vergangenen 4 Jahren konnten umfangreiche Erfahrungen in dem Einsatz dieser Substanz in diesen Indikationen gewonnen werden. In dieser Übersicht diskutieren die Autoren die derzeitigen Erkenntnisse über den Einsatz von Sorafenib bei speziellen Indikationen, bspw. bei Patienten mit eingeschränkter Leberfunktion, Patienten nach Lebertransplantation etc. Zudem werden die häufigsten Nebenwirkungen und das Management im Detail erläutert. Schließlich soll diese Übersicht auch einen Überblick über weitere experimentelle Indikationen, wie bspw. Sorafenib im Zusammenhang mit der Chemoembolisation oder anderen zielgerichteten Substanzen, geben.

Key words

hepatocellular carcinoma - sorafenib - targeted therapy

Schlüsselwörter

Leberzellkarzinom - Sorafenib - zielgerichtete Therapie

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