Analysis of cfDNA in Patients With Hepatocarcinoma and Treated by Sorafenib or Regorafenib

Inclusion Criteria:

1. Male or female patients ≥ 18 years of age
2. Histological or cytological documentation of hepatocellular carcinoma (HCC) or non-invasive diagnosis of HCC as per American Association for the Study of Liver Diseases (AASLD) criteria in patients with a confirmed diagnosis of cirrhosis
3. Patient treated for stage B hepatocellular carcinoma (multifocal disease) or stage C (metastatic disease) according to Barcelona Clinic liver cancer, regardless of treatment line, and that cannot benefit from local treatments such as resection, local ablation, chemoembolization
4. At least one uni-dimensional measurable lesion by computed tomography (CT) scan or magnetic resonance imaging (MRI) according to RECIST criteria 1.1 and modified RECIST for HCC
5. Liver function status Child-Pugh Class A
6. Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1
7. Adequate bone marrow, liver and renal function as assessed by the following laboratory tests:

   * Hemoglobin \> 8.5 g/dL
   * Absolute neutrophil count ≥ 1500/mm3
   * Platelet count ≥ 60,000/ mm3
   * Total bilirubin ≤ 2 mg/dL
   * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 x upper limit of normal (ULN)
   * Serum creatinine ≤ 1.5 x Upper limit normal (ULN)
   * Lipase ≤ 2 x ULN
   * Prothrombin time-international normalized ratio (PT-INR) \< 2.3 x ULN and partial thromboplastin time (PTT) \< 1.5 x ULN
   * Glomerular Filtration Rate (GFR) ≥ 30 mL/min/1.73 m2
8. Life expectancy ≥ 3 months
9. Women of childbearing potential and men must agree to use adequate contraception
10. Patients must be affiliated to a Social Security System
11. Written informed consent signed

    Patients initially treated with Sorafenib, will be switched to Regorafenib if all the above conditions are still met and, in addition:
12. Documented progression under treatment with Sorafenib (defined as documented radiological and/or clinical and/or biological progression)

Exclusion Criteria:

1. Prior liver transplantation or candidates for liver transplantation
2. Hypersensitivity to the active substance or to any of the excipients
3. Patients with large esophageal varices at risk of bleeding that are not being treated with conventional medical intervention
4. Past or concurrent history of neoplasm other than HCC, except for in situ carcinoma of the cervix uteri and/or non-melanoma skin cancer and superficial bladder tumors. Any cancer curatively treated \> 3 years prior to study entry is permitted
5. Known history or symptomatic metastatic brain or meningeal tumors
6. Major surgical procedure or significant traumatic injury within 28 days before enrollment
7. Congestive heart failure New York Heart Association (NYHA) ≥ class 2
8. Unstable angina or myocardial infarction within the past 6 months before enrollment
9. Cardiac arrhythmias requiring anti-arrhythmic therapy
10. Uncontrolled hypertension
11. Patients with phaeochromocytoma
12. Uncontrolled ascites
13. Persistent proteinuria of NCI-CTCAE version 4.0 ≥ Grade 3
14. Ongoing infection \> Grade 2 according to NCI-CTCAE version 4.0. Hepatitis B is allowed if no active replication is required
15. Clinically significant bleeding NCI-CTCAE version 4.0 ≥ Grade 3 within 30 days before enrollment
16. Arterial or venous thrombotic or embolic events such as cerebrovascular accident, deep vein thrombosis or pulmonary embolism within 6 months before enrollment
17. Any psychological, familial, sociological, geographical or illness or medical condition that could jeopardize the safety of the patient and/or his compliance with the study protocol and follow-up procedure
18. Known history of human immunodeficiency virus (HIV) infection
19. Seizure disorder requiring medication
20. Non-healing wound, ulcer or bone fracture
21. Active autoimmune disease (lupus, sclerodermia, rheumatoid arthritis, …)
22. Any malabsorption condition
23. Breast feeding
24. Pregnancy
25. High performance sport practice
26. Patient unable to swallow oral medication

    Patients who discontinue sorafenib will not be switched to regorafenib if any of the condition listed above occurs and/or the following criteria are met:
27. Prior discontinuation of prior Sorafenib therapy due to Sorafenib-related toxicity
28. Unresolved toxicity (Sorafenib) ≥ NCI-CTCAE version 4.0 Grade 2