Hepatocellular Carcinoma Treatment Regimens

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HEPATOCELLULAR CARCINOMA TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced health care team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The hepatocellular carcinoma cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These hepatocellular carcinoma cancer treatment regimens are provided only to supplement the latest treatment strategies.

These Cancer Treatment Guidelines are a work in progress that may be refined as often as new significant data become available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

(Revised 6/2016)

© 2016 Haymarket Media, Inc.

Unresectable Hepatocellular Carcinoma (not candidates for transplant)1

Note: All recommendations are category 2A unless otherwise indicated.

REGIMEN

DOSING

Sorafenib2,3

Sorafenib 400mg orally twice daily without food for Child-Pugh Class A (category 1) or Child-Pugh Class B.

Chemotherapya

Preferred in the context of a clinical trial.

Metastatic Hepatocellular Carcinoma1

Sorafenib2

Sorafenib 400mg orally twice daily without food.

General treatment notes:

• Sorafenib is the standard of care for unresectable and metastatic hepatocellular carcinoma in patients with Child-Pugh score A (Category 1) recommendation or Child-Pugh score B.1-2

• Treatment should continue until the patient is no longer clinically benefiting from therapy or until unacceptable toxicity occurs.

• Treatment interruption and/or dose reduction may be needed to manage suspected adverse drug reactions.

• Available safety data are limited for Child-Pugh Class B or Class C patients and dosing is uncertain.

• Use with extreme caution in patients with elevated bilirubin levels. The impact of sorafenib on patients potentially eligible for transplant is unknown.4

a There are limited data supporting the use of systemic chemotherapy and/or radiotherapy, and their use in the context of a clinical trial is preferred.

References

1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology. Hepatobiliary. v 1.2016. Available at: http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Accessed May 3, 2016.

2. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34.

3. Nexavar [prescribing information]. Wayne, NJ: Bayer HealthCare Pharmaceuticals Inc.; 2013.

4. Miller AA, Murry DJ, Owzar K, et al. Phase I and pharmacokinetic study of sorafenib in patients with hepatic or renal dysfunction: CALGB 60301. J Clin Oncol. 2009;27:1800–1805.


Gastrointestinal Cancer Drug Monographs

Colorectal and Other GI Cancers

AVASTIN CAMPTOSAR CYRAMZA
Doxorubicin HCl Doxorubicin HCl Solution ELOXATIN
ERBITUX Floxuridine Fluorouracil
FUSILEV GLEEVEC HERCEPTIN
Leucovorin LONSURF Mitomycin
NEXAVAR PHOTOFRIN STIVARGA
SUTENT TAXOTERE VECTIBIX
XELODA ZALTRAP

Pancreatic, Thyroid, And Other Endocrine Cancers

ABRAXANE AFINITOR CAPRELSA
COMETRIQ Doxorubicin HCl Doxorubicin HCl Solution
Fluorouracil GEMZAR LENVIMA
LYSODREN Mitomycin NEXAVAR
ONIVYDE SOMATULINE DEPOT SUTENT
TARCEVA THYROGEN ZANOSAR

Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.

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