Clinical characteristics and outcomes of patients with advanced hepatocellular carcinoma treated with sorafenib at Charlotte Maxeke Johannesburg Academic Hospital: A retrospective study from 2008–2016

Abstract

Background: Hepatocellular carcinoma (HCC) is a notable public health concern worldwide, with HCC incidence rates increasing over the years. In Africa, underreporting of HCC incidence due to limited definitive diagnosis, limited cancer registries and inadequate reporting in existing cancer registries are major challenges. Sorafenib has emerged as a primary systemic therapy for advanced HCC in 2008, improving survival outcomes. However, late diagnosis and limited treatment access in LMICs contribute to a poor prognosis. Methods: This retrospective study aimed to analyse the clinical characteristics and outcomes of advanced HCC patients who received Sorafenib on an Expanded Access Programme (EAP) at Charlotte Maxeke Johannesburg Academic Hospital in South Africa between 2008- 2016. Results: Forty-five patients were enrolled, with an overall median survival of 32 days. The study identified advanced liver disease at presentation as a key factor associated with early treatment discontinuation and mortality. One patient however, demonstrated a remarkable long-term response to sorafenib, suggesting the potential for tailored treatment strategies. Chronic HBV infection was a predominant risk factor while co-infection with HIV showed an association with rapid disease progression especially in younger patients. Conclusion: The findings underscore the need for improved early detection and targeted management approaches in the Southern African context. Despite the retrospective nature of the study, it provides valuable insights into HCC within the African context, emphasizing the need to address risk factors and optimise treatment outcomes.