Shimose S, Hiraoka A, Nakano M, et al. - In unresectable hepatocellular carcinoma (HCC), improved prognosis is afforded by sequential therapy with sorafenib (SORA) as the first-line treatment, and this approach was effective irrespective of HCC etiology.

• This study included 504 HCC patients treated with SORA from 2009 to 2015 (early), 2016 to 2017 (mid), and 2018 and later (late-term period).

• Of these, 180 patients who received SORA in addition to molecular-targeted agents (MTAs) in the mid- and late-term periods were split depending on disease etiology (nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steato hepatitis (NASH) [n = 37] and viral or alcohol [n = 143]).

• Sequential MTA therapy following first-line SORA offered a significantly longer overall survival (OS).

• Median survival times (MST) in early- mid- and later-time groups were 12.6 vs 17.6 vs 17.4 months, respectively.

• OS did not differ significantly between the Virus/alcohol group and the NAFLD/NASH group in those treated with sequential therapy (MST was 23.4 and 27.0 months, respectively).

• Significant factors for OS managed with SORA were: NAFLD or NASH, female gender, albumin-bilirubin grade 2b, and major Vp (Vp3/Vp4: macrovascular invasion).