الفهرس | Only 14 pages are availabe for public view |
Abstract sorafenib was approved as an appropriate treatment in patients with advanced HCC: the Sorafenib Hepatocarcinoma Assessment Randomized Protocol (SHARP) study pointed out how the median survival time and time to radiologic progression were nearly 3 months longer for patients treated with sorafenib than for those in the placebo group. Sorafenib seems to be reported are diarrhea, nausea, toxicities, including HF SR, hemorrhage. The severity of H well tolerated: the principal side effects fatigue, hypertension, and dermatological alopecia, stomatitis, erythema, and FSR is dose related, and depends on the duration, dosage, and accumulation of the drug (Llovet et al., 2008). The acneiform rash (most often acne-like) usually occurs a few day weeks from the start of treatment. Histologically, HFSR is after administration of sorafenib, and reaches a maximum after 2-3 characterized by thick, well-defined hyperkeratotic lesions frequent affecting digit flexural locations: this peculiar characteristic led to the term HFSR. Although sorafenib-induced HFSR is usually not a lifethreatening side effect, it affects quality of life in a significant manner and can be complicated by infection, pain, and limitation of activities of daily living. In addition, it represents a dose-limiting toxicity, and may compromise the efficacy of the treatment because dose reduction The Current study included 30 patients who fulfilled the pre designed inclusion criteria which were ( adult patients at least 18 years ago Patients must have histologically or cytologically confirmed or radiologically confirmed (according to AASLD criteria) advanced (unresectable, and/or metastatic) HCC not eligible for local ablation or TACE. All the Studied cases were subjected to the following: Thorough history taking including patient name, age, gender, occupation, smoking index, duration of liver disease, history of DM or hypertension , Complete Clinical examination Complete blood count. Liver function tests: ALT & AST, serum bilirubin, serum albumin , prothrombin time. Coagulation profile .Renal function tests. Amylase and 1ipase.Alfa Fetoprotein (AFP). Serum electrolytes.Radiological investigations:Pelvi-Abdominal U1trasound.Triphasic CT of abdomen and pelvis CT of chest In the present study there was a male predominance as males constituted 96.6 % of all patients and the mean of their age was 53.62 * 5.46. All patients had HCV related, Child-Pugh A chronic liver disease. Twenty one patients (70%) were BCLC C and 9 patients (30%) patients were BCLC B. Also our study revealed that there is longer median survival time in BCLC B (llmonth) than patients with BCLC C @month), but did not reach statistically significance. As regard adverse effects and their timing in our study, the overall incidene was 100%. Mostly (88%) were early timing during first three months and 15% were grade 3 to 4. The most common adverse event reported in this study was liver dysfuction which was found in 85% of patients. Constitutional symptoms were found in 48% of patients. Dermatological adverse effects were reported in 3 1% of patients. Gastrointestinal symptoms adverse events were found in 21% of patients. Moreover, abdonimal pain was noticed in 21% of patients. Only 3 (1 0%) patients developed hypertension The overall median survival of the entire cohort was 9 months in this study with 95% CI of 4.1 -14.0. The one and two year probability of survival was 44% and 39% respectively. In the present study, all patients who developed specific type adverse events had less median survival time and less TTP than those who did not experience this type of adverse events, although slight better tumour control was noticed except with thrombocytopenia. However, all these relations did not reach statistically significance. Patients who developed dermatological AE had less median survival time and less TTP than those who did not develop dermatological AE in this study although slight better tumour control. The median OS was 7 months in the group of patients with skin toxicity versus 11 months in those without skin toxicity. The median TTP was 7.5 months in the group of patients with skin toxicity versus 11.7 months in those without skin toxicity. The tumor control rate was 55.6% in patients with dermatological AE, versus 55% in patients without dermatological side effects. |