Evaluation of Gemcitabine–De Gramont Regimen In The Treatment Of Hepatocellular Carcinoma

Abstract

HCC is a neoplasm of high degree of malignancy and quite unfavorable prognosis. In Egypt, HCC is now a common malignancy which usually develops on top of liver cirrhosis of viral origin in 82% of cases. Egypt has one of the highest prevalence rates of HCV infection in the world. Both HCV and HBV infections increase the risk of HCC. Treatment of HCC depends mainly on extent of disease, the presence or absence of cirrhosis as well as degree of hepatic dysfunction. Most patients who show evidence of liver failure are seldom suitable for any active treatment. HCC is found to be resistant to conventional chemotherapy, cytabine analogues (gemcitabine) is a new anticancer agent with acceptable toxicity profile which demonstrated antineoplastic activity in many solid tumors. Few clinical trials have shown that gemcitabine appears to have antitumor activities for HCC. This is a clinical trial done on 60 patients with HCC to evaluate the role of gemcitabine with de Gramont regimen. Overall response rate was 10% (5% CR and 5% PR), 20% SD and DP in 70% of patients, TDP was two months. Toxicity was accepted with grade III and IV hepatic toxicity in 10% of patients and grade III and IV hematologic toxicity in 6.6%. Although this regimen has an acceptable toxicity profile, but it did not add much to outcome of HCC like most chemotherapeutic combinations which also carry poor response and survival rates. Studies using newer regimens and targeted therapies as well as efforts to prevent HCV and HBV infections are required to combat such aggressive disease.