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Lower dose of chemotherapy effective for liver cancer patients: Study

UPI Health News (Business)

09-07-17

Researchers at the University of Pennsylvania report that patients with a common type of liver cancer can start treatment with a lower dose of chemotherapy.

The study, published today in the Journal of Clinical Oncology, showed that patients with hepatocellular carcinoma, or HCC, who are taking the chemotherapy drug sorafenib can start with a lower dose and it will not negatively affect their outcome or length of survival.

"Previous studies have started patients with half that dose, escalating only after the patients show they can handle it, but those studies have all been on a smaller scale," Dr. Kim A. Reiss, an assistant professor of Hematology Oncology in the Perelman School of Medicine at the University of Pennsylvania, said in a press release. "We wanted to see if we could reproduce those results using a much larger cohort of patients."

HCC is the most common form of liver cancer in adults and sorafenib is the only first-line treatment approved for treatment of HCC by the U.S. Food and Drug Administration. However, sorafenib is known for adverse side effects with a recent study finding 85 percent of patients experiencing adverse side effects -- and 31 percent of patients experiencing severe enough side effects to stop treatment.

Researchers analyzed patient data from a Veterans Health Administration database and identified 5,000 HCC patients who were treated with sorafenib between 2006 and 2015.

"One of the challenges that we faced was that the sickest patients tended to get the reduced dose because of concerns over how much they could tolerate, so any attempt to evaluate these groups based on how long they lived was skewed," Reiss said.

Reiss and her team overcame that problem by matching patients from each group based on disease stage, overall health and other factors resulting in 1,675 patients.

"Essentially, we used a computer model to simulate putting these patients into a randomized, controlled clinical trial," said Dr. David E. Kaplan, an assistant professor of Gastroenterology and an associate professor of Medicine at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia.

The study found that the reduced dose had no effect on overall survival. Patients beginning treatment at a lower dose had an average survival of 198 days compared to 195 days for patients starting on a full dose, the researchers report.

The lower dose resulted in significant cost savings of about an average of $3,000 per patient and significantly reduced adverse side effects.

"It's important to remember that the reduced dose patients will ramp up as they show they can handle it, while the full dose patients may have to ramp down because of these toxicities, so the dosage levels will converge in the middle," Reiss said. "All of the patients get the treatment they need, but the reduced dose approach helps keep cost and toxicities down."

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