Positioning and indication of sorafenib in the treatment algorithm and real practice setting: Western and eastern...

Hepatocellular carcinoma (HCC) is common in Asia, and there were no effective chemotherapeutic agents for advanced HCC. Sorafenib, an oral multikinase inhibitor, has set a milestone in the management of HCC in that it is the first agent to significantly improve the overall survival in patients with advanced HCC in a double-blind, placebo-controlled, phase III study. Sorafenib is now approved in many Asian countries, and further clinical trials are underway. There is no doubt that sorafenib has a firm position at the core of HCC therapy, and its indications are anticipated to widen in the near future to intermediate HCC or as an adjuvant agent with or without combination modality. However, the clinical outcome with sorafenib is not completely satisfactory in patients with extrahepatic spread or macrovascular invasion. Furthermore, sorafenib is expensive, which puts it beyond the reach of most Asian patients. Therefore, the development and customization of a rational approach based on cost, quality of life, and survival are urgently needed. Finally, a practical consensus guideline is needed based on clinical trials in Asia.