Do you recommend starting sorafenib at a reduced dose and titrating up in patients with advanced hepatocellular carcinoma?

Yes, I do. In our recent, large retrospective analysis of nearly 5,000 patients with HCC, we noted that starting at a lower dose of sorafenib and titrating up as tolerated (1) did not adversely affect OS and (2) resulted in less toxicity and cost to patients (Reiss et al, JCO). In this setting, I th...

I always start sorafenib at a reduced dose (400 mg daily in patients with good PS and mild liver dysfunction, 200 mg daily in patients with borderline PS or total bilirubin >2.5) and then titrate up based on clinical and laboratory parameters. I rarely prescribe sorafenib when the baseline total bil...