International and multicenter real-world study of sorafenib-treated patients with hepatocellular carcinoma under dialysis.

Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population.We report a multicenter study comprising patients from Latin America and Europe. Patients treated with sorafenib were enrolled; demographics, dose modifications, adverse events, treatment duration, and outcome of patients undergoing dialysis were recorded.As of March 2018, 6156 hepatocellular carcinoma patients were treated in 44 centers and 22 patients were concomitantly under dialysis (0.36%). The median age was 65.5 years, 40.9% had hepatitis C, 75% had Child-Pugh A, and 85% were BCLC-C. The median time to first dose modification, treatment duration, and overall survival rate were 2.4 months (IQR, 0.8-3.8), 10.8 months (IQR, 4.5-16.9), and 17.5 months (95%CI, 7.2-24.5), respectively. Seventeen patients required at least 1 dose modification. The main causes of first dose modification were asthenia/worsening of ECOG-PS and diarrhea. At the time of death or last follow-up, four patients were still on treatment and 18 had discontinued sorafenib: 14 were due to tumor progression, 2 were sorafenib-related, and 2 were non-sorafenib-related AE.The outcomes observed in this cohort seem comparable to those in the non-dialysis population. Thus, to the best of our knowledge, this is the largest and most informative dataset regarding systemic treatment outcomes in hepatocellular carcinoma patients undergoing dialysis.