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ASCO 2014:索拉非尼是否可预防中高复发风险的肝细胞癌复发(STORM研究)?

2014-05-31 MedSci MedSci原创

索拉非尼是一种多激酶抑制剂,已证明对不能手术切除的肝细胞癌有效。研究人员对手术切除或局部消融的高复发的肝细胞癌(HCC)患者给予索拉非尼辅助治疗的疗效和安全性进行评估。该项STORM试验,是用来评估使用索拉非尼预防肝细胞癌复发的一项III期随机,双盲,安慰剂对照试验。以根治性为目的接受手术切除或者局部消融,以及有中高级复发风险的患者均符合该试验要求。主要入选标准包括Child-Pugh评分5~7,

索拉非尼是一种多激酶抑制剂,已证明对不能手术切除的肝细胞癌有效。研究人员对手术切除或局部消融的高复发的肝细胞癌(HCC)患者给予索拉非尼辅助治疗的疗效和安全性进行评估。该项STORM试验,是用来评估使用索拉非尼预防肝细胞癌复发的一项III期随机,双盲,安慰剂对照试验。

以根治性为目的接受手术切除或者局部消融,以及有中高级复发风险的患者均符合该试验要求。主要入选标准包括Child-Pugh评分5~7,ECOG PS 0,经CT或者MRI确认没有残留病灶。排除标准为复发性HCC,腹水,肝外转移,大血管浸润,和先前接受HCC系统治疗。按照根治性治疗方式,地理区域,复发风险,和Child-Pugh状态将患者进行分层,以1:1比例将患者分为接受索拉非尼400mg 口服 每日两次或者安慰剂,最长维持时间4年。根据独立审查主要终点是无复发生存期(RFS)。次要终点包括复发时间(TTR)和总生存期(OS)。

共有1114例患者被随机分配到索拉非尼组(n=556)和安慰剂组(n=558)。两组之间的基线特征被平衡。中位年龄是59岁,62%的亚洲人,81%接受手术切除术,97%为Child-Pugh A,并且有46%存在高复发风险。基于464例RFS事件进行分析。RFS,TTR和OS观察到没有明显差异(表)。索拉非尼组有一个较短的中位治疗维持时间(12.5个月 vs 22.2个月),以及较低的中位日常剂量(578mg vs 778mg)。由于治疗中出现的不良反应事件(TEAE)索拉非尼组的停药率较高(24% vs 7%),同意撤出试验(17% vs 6%)。最常见的3~4级(Gr)TEAEs发生在索拉非尼组更为频繁,与安慰剂组比较,主要是手足皮肤反应(28%),高血压(7%),和腹泻(6%)。

该试验的主要终点未能满足。不良反应与已知的索拉非尼安全特性相一致,没有新的安全性结果被观察到。

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    2014-11-24 xjy02
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    2015-01-06 quxin068
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