Summary: Background: The positive results of the REFLECT trial in terms of survival (sorafenib vs lenvatinib) offer a new first‐line option for hepatocellular carcinoma. Additionally, the expected results of immunotherapy could change the first‐line treatment in hepatocellular carcinoma or the clinical trial design in first and second‐line.Aims: To evaluate the impact of dermatologic adverse events under sorafenib in hepatocellular carcinoma patients as a clinical marker to predict prognosis and critically evaluate outcomes within trials.Methods: A systematic search of original articles published until October 2018 was performed using PubMed/MEDLINE and a meta‐analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement.Results: A total of 393 studies were identified and 13 articles with 2035 patients (79.5% Child‐Pugh‐A, 73.2% BCLC‐C) were selected for qualitative and quantitative analysis. The main type of dermatologic adverse events was hand‐foot skin reaction (47.7%) but other dermatologic adverse events were reported in 31.7% of the cases. Presence of dermatologic adverse events was associated with a lower mortality when compared with those patients without them (pooled Hazard Ratio for the univariate analysis 0.45 (95% CI: 0.38‐0.53) and there was no heterogeneity for the analysis (P = 0.511; I² = 0.0%). Refuting this association would require the future report of 1370 negative studies.Conclusions: This meta‐analysis shows a clinically meaningful association between dermatologic adverse events and a higher probability of longer survival. These data support the use of dermatologic adverse events in the clinical decision‐making when informing the prognosis and when systemic treatment is decided.

Sorafenib demonstrated a survival benefit in the treatment of advanced hepatocellular carcinoma (HCC) in phase III trials. However, almost all the patients included in those trials exhibited well‑preserved liver function (Child‑Pugh A). The aim of this study was to describe our experience with sorafenib in Child‑Pugh B HCC patients. A database of patients with advanced HCC treated with sorafenib was retrospectively evaluated. The median overall survival of Child‑Pugh B patients (n=20) was 2.53 months [95% confidence interval (CI): 0.33‑5.92 months] and of Child‑Pugh A patients (n=100) 9.71 months (95% CI: 6.22‑13.04). Child‑Pugh B patients had a significantly poorer survival compared to Child‑Pugh A patients (P=0.002). The toxicities were similar between the two groups. Metastasis, vascular invasion and α‑fetoprotein level >1,030 ng/ml were not associated with survival among Child‑Pugh B patients (P=0.281, 0.189 and 0.996, respectively). Although the survival outcomes were worse in Child‑Pugh B patients treated with sorafenib, the toxicity profile was manageable. Therefore, there remains the question of whether to treat this subgroup of patients and more data are required to define the role of sorafenib in the context of liver dysfunction.

Background & Aims: Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population. Methods: Multicentre retrospective, cross‐sectional, international study of liver cancer patients with SARS‐CoV‐2 infection registered between February and December 2020. Clinical data at SARS‐CoV‐2 diagnosis and outcomes were registered. Results: Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA). The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS‐CoV‐2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow‐up of 7.20 (IQR: 1.84–11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS‐CoV‐2‐related. Forty (18.4%) HCC patients died within 30‐days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24–12.74], 11.76% [95% CI 4.73–22.30], 20.69% [95% CI 11.35–31.96] and 34.52% [95% CI 17.03–52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49–4.31; p = .5032) in BCLC‐B versus 0/A, and 3.13 (95% CI 1.29–7.62; p = .0118) in BCLC‐C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS‐CoV‐2 infection. Conclusions: This is the largest cohort of liver cancer patients infected with SARS‐CoV‐2. It characterizes the 30‐day mortality risk of SARS‐CoV‐2 infected patients with HCC during this period.

A 55-year old man was treated with sunitinib 50 mg/day for 4 weeks on and 2 weeks off, as a first-line therapy for metastatic renal cell carcinoma. During the fourth week of the first cycle, he was admitted to the Emergency Department with abdominal pain and vomiting. Acute acalculous cholecystitis was diagnosed. Sunitnib-associated cholecystitis is a rare adverse event previously reported in few cases. The mechanism behind this complication is not fully understood, although vascular endothelial dysfunction may play a role. The use of this drug is expanding in clinical oncology, and physicians should be aware of this life-threating adverse event.