Liver cancer is the fifth most common solid malignancy and the second most common cause of cancer-related death worldwide. So far, curative treatment options, such as resection, ablation or transplantation, are only feasible in early stages of HCC. However, a large number of newly diagnosed HCC are staged as more advanced. For these patients, TACE is a local palliative treatment option (BCLC B) and in 2007 sorafenib has been introduced as first systemic agent (BCLC C). Since then, all trials investigating combination therapy have been futile. Clinically, the combination of highly selective embolization of mainly arterially vascularized HCC to inhibit tumour perfusion with the antiangiogenic and antiproliferative effect of sorafenib appears beneficial. The aim of our study was to evaluate combination therapy (sorafenib and additive TACE) in individual cases of advanced HCC (BCLC C) in terms of treatment course, adverse drug reactions (ADR), adverse events (AE) and gain of lifetime. Out of a total of 148 patients with HCC who had received at least one TACE between November 1, 2007 and December 31, 2010, we identified 19 patients with BCLC C who received multimodal therapy with at least one sorafenib administration within 3 months to TACE. Data were collected retrospectively on liver function, cirrhosis stage, tumour stage, gender, age, aetiology, sorafenib therapy, TACE procedures, ADR and survival. The study group was composed of 16 men and 3 women. BCLC C status was based on vascular invasion (n = 10), portal vein thrombosis (n = 11), and detection of metastases (n = 11). Three patients were classified as BCLC C in the patient file and therefore initially treated with sorafenib, but no information on metastasis and / or vascular invasion was available for these patients. Seventeen patients had liver cirrhosis at baseline, only one patient had a higher degree of hepatic impairment and impairment in PST (Child-Pugh B and ECOG 2). The other patients had no risk factors (Child-Pugh A or no liver cirrhosis, ECOG 0 or 1). The leading underlying aetiologies were viral hepatitis (58In summary, patients with well-maintained liver function (Child-Pugh A) and reasonable performance status (ECOG 0 or 1) may benefit from combination therapy in selected cases (limited extrahepatic tumour burden, sufficient accessibility of intrahepatic foci by TACE). The influence of cirrhosis and the underlying aetiology on the response and the tolerability of such a multimodal therapy must be clarified in randomized prospective trials or in larger retrospective studies.
