Pancreatic enzymes supplementation leads to symptomatic recovery in sorafenib-treated HCC

Supplementation with pancreatic enzymes results in symptomatic recovery in hepatocellular carcinoma (HCC), as shown in a study that validated the association between malabsorption (MA) and pancreatic insufficiency (PI) in 10 percent of sorafenib-treated patients.

“Awareness of this adverse event can help in the management of sorafenib irrespective of cancer type and … of other tyrosine kinase inhibitors for HCC patients,” the authors said.

Endoscopy, serum markers, and imaging techniques were used to prospectively examine all sorafenib-treated patients with suspicion of MA, defined as decreased stool consistency lasting >4 weeks or presenting ≥10 percent body weight loss without HCC progression.

Eighty-one sorafenib-treated patients were evaluated, of whom 21 developed MA suspicion (85.7 percent male; 81.5 percent Child-Pugh A, 52.4 percent BCLC-B, and 47.6 percent BCLC-C) within a median 5.9 months following treatment initiation.

The median treatment duration was 5.9 months and follow-up 20.3 months. Median overall survival after MA suspicion was 20.3 months.

Nine patients (42.9 percent) had hyperparathyroidism secondary to vitamin D deficiency, and eight presented with PI. Patients with PI showed a gradual decrease in pancreatic volume of up to 19 percent. Six of them received pancreatic enzymes, with complete recovery from MA symptoms and stabilization of pancreatic volume.

“With the increasing options of second-line systemic therapies for HCC, the recognition of drug intolerance using practical tools is crucial,” the authors said. “It has been proposed that a MA syndrome could be due to sorafenib-induced pancreatic dysfunction.”