Sorafenib with or without concurrent transarterial chemoembolization in hepatocellular carcinoma: a cautionary comment of STAH trial

Conventional transarterial chemoembolization (cTACE) and sorafenib are the standard monotherapy for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) stage B or C by Western official guidelines (1,2). Many large randomized controlled trials have shown these two monotherapies to extend median overall survival over the best supportive care in such patients. cTACE would induce the upregulation of angiogenic factors by ischemic liver injury. Therefore, anti-angiogenic agent therapy concurrents cTACE, such as sorafenib plus cTACE, may complementarily inhibit angiogenic factors and tumor growth. Just under such a background, the STAH trial, which was published in a recent issue of Journal of Hepatology, was designed to assess the efficacy and safety of sorafenib concurrents cTACE in patients with advanced HCC (3)