Sunitinib combined with transarterial chemoembolization versus transarterial chemoembolization alone for advanced-stage hepatocellular carcinoma: a propensity score matching study

Sunitinib is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenic activity. The aim of this study was to compare the efficacy of sunitinib combined with transarterial chemoembolization (TACE) versus TACE alone for treating patients with advanced-stage hepatocellular carcinoma (HCC). Of 103 patients with advanced-stage HCC, 38 (36.9 %) received TACE combined with sunitinib therapy (combined group) and the remaining 65 patients (63.1 %) received TACE alone (monotherapy group). The primary endpoint was overall survival (OS) and the secondary endpoints were time to progression (TTP) and treatment-related adverse events. Propensity score-based methods were used to minimize bias. The response rate was 15.8 % (6 of 38 patients) in the combined group and 10.8 % (7 of 65 patients) in the monotherapy group ( P = 0.031). The median OS and TTP in the combined group were longer than those in the monotherapy group (OS, 8.8 vs 6.3 months; P = 0.029 and TTP, 3.9 vs 2.5 months; P = 0.002). In the propensity score-matched cohort (38 pairs), the median OS in the combined group was significantly longer than that in the monotherapy group (8.8 vs 6.5 months, respectively; P = 0.044), and the median TTP was also longer in the combined group (3.9 vs 2.6 months, respectively; P = 0.003). Significant prognostic factors for OS by multivariate analysis included the use of sunitinib, Child-Pugh scores, vascular invasion, distant organ metastasis, and serum AFP level. This study suggests that sunitinib plus TACE are superior to TACE alone with respect to OS and TTP in patients with advanced-stage HCC.