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      GIDEON (Global Investigation of therapeutic DEcisions in hepatocellular carcinoma and Of its treatment with sorafeNib): second interim analysis

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          Abstract

          Background

          GIDEON (Global Investigation of therapeutic DEcisions in hepatocellular carcinoma [HCC] and Of its treatment with sorafeNib) is a global, prospective, non-interventional study undertaken to evaluate the safety of sorafenib in patients with unresectable HCC in real-life practice, including Child-Pugh B patients who were excluded from clinical trials.

          Methods

          Patients with unresectable HCC, for whom the decision to treat with sorafenib, based on the approved label and prescribing guidelines, had been taken by their physician, were eligible for inclusion. Demographic data and disease/medical history were recorded at entry. Sorafenib dosing and adverse events (AEs) were collected at follow-up visits. The second interim analysis was undertaken when ∼1500 treated patients were followed up for ≥ 4 months.

          Results

          Of the 1571 patients evaluable for safety, 61% had Child-Pugh A status and 23% Child-Pugh B. The majority of patients (74%) received the approved 800 mg initial sorafenib dose, regardless of Child-Pugh status; however, median duration of therapy was shorter in Child-Pugh B patients. The majority of drug-related AEs were grade 1 or 2, and the most commonly reported were consistent with previous reports. The incidence and nature of drug-related AEs were broadly similar across Child-Pugh, Barcelona Clinic Liver Cancer (BCLC) and initial dosing subgroups, and consistent with the overall population.

          Conclusions

          Consistent with the first interim analysis, overall safety profile and dosing strategy are similar across Child-Pugh subgroups. Safety findings also appear comparable irrespective of initial sorafenib dose or BCLC stage. Final analyses in > 3000 patients are ongoing.

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          Most cited references16

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          Management of hepatocellular carcinoma.

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            The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence.

            We conducted a systematic review and a meta-analysis to estimate the magnitude and determinants of association between diabetes and hepatocellular carcinoma (HCC). MEDLINE searches were conducted for published full studies (between January 1966 and February 2005) that provided risk estimates and met criteria concerning the definition of exposure and outcomes. Two investigators independently performed standardized search and data abstraction. Unadjusted and adjusted odds ratios for individual outcomes were obtained or calculated for each study and were synthesized using a random-effects model. A total of 26 studies met our inclusion and exclusion criteria. Among 13 case-control studies, diabetes was associated significantly with HCC in 9 studies (pooled odds ratio, 2.5; 95% confidence interval, 1.8-3.5). Among 13 cohort studies, diabetes was associated significantly with HCC in 7 studies (pooled risk ratio, 2.5; 95% confidence interval, 1.9-3.2). The results were relatively consistent in different populations, different geographic locations, and a variety of control groups. The significant association between HCC and diabetes was independent of alcohol use or viral hepatitis in the 10 studies that examined these factors. Few studies adjusted for diet and obesity. Diabetes is associated with an increased risk for HCC. However, more research is required to examine issues related to the duration and treatment of diabetes, and confounding by diet and obesity.
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              Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies

              Background Although there are many studies of the predictors of death in hepatocellular carcinoma (HCC), most combine patients with and without cirrhosis and many combine those with compensated and decompensated cirrhosis. Objective To perform a systematic review of the literature evaluating the predictors of death in patients with cirrhosis and HCC and to evaluate whether the predictors differ between patients with compensated and decompensated cirrhosis. Methods Inclusion criteria: (i) publication in English, (ii) adult patients, (c) >80% of the patients had cirrhosis, (iv) follow-up >6 months and (v) multivariable analysis. Quality was based on the accepted quality criteria for prognostic studies. Results Of the 1106 references obtained, 947 were excluded because they did not meet the inclusion criteria. A total of 23 968 patients were included in 72 studies (median, 177/study); 77% male, median age 64, 55% Child–Pugh class A. The most robust predictors of death were portal vein thrombosis, tumour size, α-foetoprotein and Child–Pugh class. Sensitivity analysis using only 15 ‘good’ studies and 22 studies in which all patients had cirrhosis yielded the same variables. In the studies including mostly compensated or decompensated patients, the predictors were both liver and tumour related. However, these studies were few and the results were not robust. Conclusions This systematic review of 72 studies shows that the most robust predictors of death in patients with cirrhosis and HCC are tumour related and liver related. Future prognostic studies should include these predictors and should be performed in specific patient populations to determine whether specific prognostic indicators are more relevant at different stages of cirrhosis.
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                Author and article information

                Journal
                Int J Clin Pract
                Int. J. Clin. Pract
                ijcp
                International Journal of Clinical Practice
                BlackWell Publishing Ltd (Oxford, UK )
                1368-5031
                1742-1241
                May 2014
                28 November 2013
                : 68
                : 5
                : 609-617
                Affiliations
                [1 ]Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine Pisa, Italy
                [2 ]Department of Gastroenterology and Hepatology, Kinki University School of Medicine Osaka, Japan
                [3 ]Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai, China
                [4 ]Department of Gastroenterology and Hepatology, INSERM U954, University Hospital, University of Lorraine Nancy, France
                [5 ]Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China
                [6 ]Policlínica Metropolitana Caracas, Venezuela
                [7 ]Kyorin University School of Medicine Mitaka, Tokyo, Japan
                [8 ]Vascular and Interventional Radiology, Johns Hopkins University School of Medicine Baltimore, MD, USA
                [9 ]Hospital Angeles Clínica Londres Mexico City, Mexico
                [10 ]University Hospital of Larissa Larissa, Greece
                [11 ]Department of Digestive Surgery, Nihon University School of Medicine Tokyo, Japan
                [12 ]The Catholic University of Korea Seoul, Korea
                [13 ]Global Medical Affairs, Bayer HealthCare Pharmaceuticals Montville, NJ, USA
                [14 ]Clinical Statistics, Bayer HealthCare Pharmaceuticals Montville, NJ, USA
                [15 ]Global Medical Affairs and Pharmacovigilance, Bayer HealthCare Pharmaceuticals Berlin, Germany
                [16 ]Virginia Commonwealth University Medical Center Richmond, VA, USA
                Author notes
                Correspondence to:, Professor Riccardo Lencioni, Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Pisa, Italy, Tel.: +39 050 997 321, Fax: +39 050 996 561, Email: riccardo.lencioni@ 123456med.unipi.it

                ClinicalTrials.gov identifier: NCT00812175

                Disclosures Riccardo Lencioni has participated in a speaker bureau with Bayer; Jean-Pierre Bronowicki has a consulting role with Bayer; Junji Furuse has a consulting role with Bayer, has participated in a speaker bureau with Bayer and has received a research grant from Bayer; Jeff F. Geschwind has a consulting role with Bayer and has received a research grant from Bayer; Laura Ladróon de Guevara has a consulting role with Bayer; Christos Papandreou has a consulting role with Bayer and has received a travel grant from Bayer; Keiko Nakajima is an employee of Bayer and has stock ownership with Bayer; Robert Lehr and Stephanie Heldner are employees of Bayer; Masatoshi Kudo, Sheng-Long Ye, Xiao-Ping Chen, Lucy Dagher, Tadatoshi Takayama, Seung Kew Yoon and Arun J. Sanyal have no financial interests to disclose.

                Article
                10.1111/ijcp.12352
                4265239
                24283303
                05fc84ec-4af7-4ff6-ab46-0b16ee90d3fc
                © 2013 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : July 2013
                : October 2013
                Categories
                Oncology

                Medicine
                Medicine

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