Sorafenib With TACE to Treat Hepatocellular Carcinoma

Inclusion criteria

• Patients with inoperable HCC, who are candidates for transarterial chemoembolization (TACE).
• Diagnosis of hepatocellular carcinoma based on the EASL's criteria (1).
• Child-Pugh score < 10 (Child A or B),
• Life expectancy superior to 12 weeks at the pre-treatment evaluation.
• Local therapies have been interrupted for at least 4 weeks
• Written informed consent signed
• Age >= 18
• Performance status ECOG 0-1
• Normal organ and marrow function defined as:

• Haematopoietic: absolute neutrophil count >1,500/mm3, platelet count > 60,000/mm3, haemoglobin > 9g/dL
• INR < 1.5 ULN and PTT within normal limits
• Hepatic: AST or ALT < 5 x ULN
• Renal: creatinine < 1.5 x ULN
• Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment
• Women of childbearing potential and men must agree to use adequate birth contraception (must be double and methods recorded) prior to study entry and for the duration of the study participation. For both men and women, these adequate birth control measures must be used for at least 3 months after the last administration of study drug.

Exclusion criteria

• Active heart disease is defined as congestive heart failure >NYHA (New York Heart Association) class 2; active coronary artery disease (myocardial infarction more than 6 months prior to study entry is allowed); cardiac arrhythmias requiring anti-arrhythmic therapy (beta-blockers or digoxin are permitted) or uncontrolled hypertension.

• Congestive heart failure, serious cardiac arrhythmia, active coronary artery disease.
• Thrombotic or embolic events within the past 6 months such as a cerebrovascular accident (including transient ischemic attacks), pulmonary embolism.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection.
• Psychiatric illness/social situations that would limit compliance with study requirements.
• Patients with evidence of active infection will become eligible for reconsideration 7 days after completing antibiotic therapy.
• HIV-positive patients receiving combination anti-retroviral therapy are excluded from the study because of possible pharmacokinetic interactions with sorafenib.
• Patients who have been treated with sorafenib.
• Cerebral metastasis.
• Child-Pugh score C.
• Hypertension defined as systolic blood pressure greater than 150 mmHg or diastolic pressure greater than 90 mmHg despite optimal medical management.
• Proteinuria defined as a 24-hour urine protein excretion greater than 1000 mg. Urine dipstick proteinuria of 1+ or greater will require a 24-hour urine to determine eligibility for enrolment.
• Therapeutic anticoagulation with coumarin, heparins, or heparinoids.
• Serious non-healing wounds (including wounds healing by secondary intention), acute or non-healing ulcers, or bone fractures within 3 months of fracture.
• Evidence of bleeding diathesis.
• Impairment of swallowing that would preclude administration of sorafenib.
• History of haemoptysis or surgery within the past 28 days.
• Organ allograft.
• Pregnant or breastfeeding patients.