LEONARDO GOMES DA FONSECA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC(2023) PINEROA, Federico; ANDERS, Margarita; BERMUDEZ, Carla; DEMIRDJIAN, Ezequiel; VARON, Adriana; PALAZZO, Ana; RODRIGUEZ, Jorge; BELTRAN, Oscar; FONSECA, Leonardo Gomes da; RIDRUEJO, Ezequiel; CABALLINI, Pablo; TAMAGNONE, Norberto; REGGIARDO, Virginia; CHEINQUER, Hugo; ARAUJO, Alexandre; ARUFE, Diego; MARIN, Juan Ignacio; RATUSNU, Natalia; MANERO, Estela; PEREZ, Daniela; VILLA, Marina; OROZCO, Federico; MURGA, Dolores; MARCIANO, Sebastian; BESSONE, Fernando; SILVA, Marcelo; MENDIZABAL, ManuelIntroduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular car-cinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real -world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic varia-bles and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, esti-mating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enroll-ment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was inde-pendently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initi-ated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first -line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decom-pensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. Conclusions: The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists. (c) 2023 Fundacion Clinica Medica Sur, A.C.
- Expanding TACTICS trial into a different setting in hepatocellular carcinoma(2020) FONSECA, Leonardo da; CARRILHO, Flair JoseSystemic treatment for hepatocellular carcinoma (HCC) is recommended for patients with advanced stage and for those who progressed on locoregional modalities. The first agent approved for advanced HCC was sorafenib, and it remains one of the cornerstones of systemic treatment. In the past years, immunotherapy has shown promising results and has been incorporated into the treatment armamentarium. The rates of recurrence and progression after locoregional therapies are significant, what highlights the need to explore systemic agents for preventing or delaying these negative outcomes. Recently, sorafenib was shown to benefit patients with unresectable HCC under transarterial chemoembolization (TACE) by delaying tumor progression and prolonging time to vascular invasion and extrahepatic spread. Although this result was reported in patients with intermediate stage, it provides background to test the strategy of combining systemic treatment plus TACE as a bridge therapy to HCC patients awaiting liver transplantation, for which the risk of dropout due to tumor progression impairs the possibility of cure. (c) 2020 Fundacion Clinica Medica Sur, A.C.