Hepatotoxicity induced by
sorafenib and
antiviral therapy is a limitation for its continuation treatment for patients with advanced hepatitis B virus-related
hepatocellular carcinoma (HCC). This prospective study determined the efficacy of
tiopronin in hepatotoxicity prevention of HBV-related HCC treatment. Eighty-two patients (median age, 50 years; 71 % male) of advanced HCC treated with
sorafenib and
antiviral therapy were included, of whom 40 were given the supplementation of
tiopronin. The primary endpoint was liver function which was checked before the treatment and every week during the
therapy. Besides, course discontinuations,
dose reductions, HBV
DNA levels and treatment efficacy were evaluated. Patient characteristics and liver function were comparable (p > 0.05). The proportion of abnormal liver function was significantly lower in
tiopronin group than in control group including
alanine transaminase (ALT, p = 0.035),
aspartate aminotransferase (AST, p = 0.041), total
bilirubin (TBIL, p = 0.021) and
albumin (ALB, p = 0.001). Rates of course discontinuations (p = 0.024) and
dose reductions (p = 0.046) were significantly lower in
tiopronin groups, and disease control rate (p = 0.036) was higher. No difference was found in HBV
DNA level. Multivariate regression analysis showed that
sorafenib (OR 7.837; 95 % CI 3.845-15.333; p = 0.004),
antiviral therapy (OR 3.871; 95 % CI 1.572-9.569; p = 0.044) and hepatoprotective drug (OR 3.007; 95 % CI 1.321-6.308; p = 0.046) played important roles in clinical outcome.
Tiopronin tends to prevent the HCC patients from the treatment-induced hepatotoxicity, enhance patients' tolerance to
sorafenib and
antiviral therapy and even improve the
cancer treatment efficacy.