Up-titration of sorafenib for hepatocellular carcinoma: Impact on duration of exposure and cost.

385Background: Few data exist how sorafenib starting dose impacts duration of exposure and cost of sorafenib therapy for patients with HCC. Methods: HCC patients exposed to sorafenib, initial doses, number of sorafenib fills, and medication exposure days were identified from the VA CDW using ICD9 codes and pharmacy records. ICD9 codes, CPT codes, AUDIT-C surveys and laboratory tests were utilized to characterize underlying liver disease, calculate Child-Turcotte-Pugh (CTP) and MELD scores. Two abstractors achieved 100% chart verification of tumor number, size, MVI/EHS on imaging proximate to sorafenib to quantify Barcelona Clinic Liver Cancer (BCLC) stage and to determine the provider specialty initiating sorafenib. Results: 2292 patients with BCLC B-C HCC, CTP A cirrhosis with ECOG PS ≤ 2 prescribed sorafenib for HCC between 2007 and 2015 were included in this interim analysis. Median age was 62; 98.8% were male, 61.8% white/26.0% black; Pre-sorafenib BCLC B-43%/C-57%. Prescription at full-dose became le...