Bolondi Luigi, Craxi Antonio, Trevisani Franco, Daniele Bruno, Di Costanzo Giovan Giuseppe, Fagiuoli Stefano, Cammà Calogero, Bruzzi Paolo, Danesi Romano, Spandonaro Federico, Boni Corrado, Santoro Armando, Colombo Massimo
Division of Internal Medicine, Department of Medical & Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital, Bologna, Italy.
Future Oncol. 2015;11(3):449-65. doi: 10.2217/fon.14.261. Epub 2014 Oct 31.
Understanding the best use of sorafenib is essential in order to maximize clinical benefit in hepatocellular carcinoma. Based on Phase III and noninterventional study data, as well as our extensive experience, we discuss dose modification in order to manage adverse events, disease response evaluation and how to maximize treatment benefit. Sorafenib should be initiated at the approved dose (400 mg twice daily) and reduced/interrupted as appropriate in order to manage adverse events. Dose modification should be considered before discontinuation. Appropriate tumor response assessment is critical. Focusing on radiologic response may result in premature sorafenib discontinuation; symptomatic progression should also be considered. If second-line therapies or trials are unavailable, continuing sorafenib beyond radiologic progression may provide a clinical benefit. Our recommendations enable the maximization of treatment duration, and hence clinical benefit, for patients.
为了在肝细胞癌中使临床获益最大化，了解索拉非尼的最佳使用方法至关重要。基于III期和非干预性研究数据以及我们的丰富经验，我们讨论了为应对不良事件而进行的剂量调整、疾病反应评估以及如何使治疗获益最大化。索拉非尼应按批准剂量（每日两次，每次400毫克）起始用药，并根据需要减少剂量或中断用药以应对不良事件。在停药前应考虑调整剂量。进行适当的肿瘤反应评估至关重要。仅关注影像学反应可能导致索拉非尼过早停药；还应考虑症状性进展。如果没有二线治疗方案或试验可用，在影像学进展后继续使用索拉非尼可能会带来临床获益。我们的建议能够使患者的治疗持续时间最大化，从而使临床获益最大化。
