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The phase III randomized trial comparing sunitinib versus sorafenib have enrolled 1074 patients around the world, 76% of the patients were from Asia. Although this study was prematurely terminated, it provided important information. It showed major region-to-region and country-to-country variation in outcome of patients under the same treatment of molecular targeted agents. The exact reason for this is unclear, but different viral etiologies and different clinical practice patterns may have played major roles. It also showed a trend toward earlier use of molecular targeted agents, at least in the clinical trial setting, in Asia. Oncololtic virus, JX-594, has been tested in phase II studies primarily in Korea. The preliminary data, either alone or in combination with sorafenib, were encouraging. A randomized phase II study in Taiwan revealed borderline effect of vandetanib (inhibitor of VEGFR and EGFR) in HCC. Several phase II studies for the combinations of metronomic chemotherapy and anti-angiogenic agents such as sorafenib, bevacizumab, and thalidomide suggested improved efficacy without additional toxicity. Many early proof-of-concept trials, as well as large-scale decisive phase III trials are now ongoing in Asia.

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