Sorafenib use in the transplant setting.

Area of Science:

• Hepatobiliary Surgery
• Medical Oncology
• Transplant Medicine

Background:

• Liver transplantation (LT) is a standard treatment for hepatocellular carcinoma (HCC).
• Sorafenib (SFN) is approved for advanced HCC, but its role alongside LT is unclear.
• Potential toxicities, especially with mTOR inhibitor immunosuppressants, warrant investigation.

Purpose of the Study:

• To review current evidence on the use of SFN in conjunction with LT for HCC.
• To evaluate the efficacy and cost-effectiveness of SFN in neoadjuvant, adjuvant, and recurrence settings.
• To assess the safety profile of SFN, considering potential interactions with immunosuppressants.

Main Methods:

• Systematic review of existing literature on SFN and LT for HCC.
• Analysis of studies examining SFN use before, during, and after LT.
• Evaluation of reported toxicity data and impact on immunosuppressive regimens.

Main Results:

• Current data do not support the use of SFN in the pre- or post-LT setting for HCC.
• Evidence regarding the efficacy and cost-effectiveness of SFN in combination with LT is insufficient.
• Toxicity concerns, particularly with mTOR inhibitors, require careful consideration.

Conclusions:

• The combination of SFN with LT for HCC is not currently recommended based on available evidence.
• Further clinical trials are necessary to establish the safety and efficacy of SFN in the context of LT.
• Optimal treatment strategies for advanced HCC in patients undergoing or eligible for LT require additional research.