Improved survival with oral administration of enteric‐coated tegafur/uracil for advanced stage IV‐A hepatocellular carcinoma

Ishikawa, Toru; Ichida, Takafumi; Sugitani, Soichi; Tsuboi, Yasunori; Genda, Takuya; Sugahara, Satoshi; Uehara, Kazuhiro; Inayoshi, Jun; Yokoyama, Junji; Ishimoto, Yuiko; Asakura, Hitoshi

doi:10.1046/j.1440-1746.2001.02352.x

Cited by 58 publications

(50 citation statements)

References 14 publications

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“…28 Regarding the core group, 4 studies compared treatment versus conservative management 29,30,32,33 and 2 compared treatment versus suboptimal therapies (one using systemic chemotherapy with 5-fluorouracil 27 and one using oral tamoxifen 31 ). Four studies included 2 73 IV doxorubicin ϩ VM26 ϩ 5-FU (n ϭ 74 IV 75 IV deoxydoxorubicin (n ϭ 76 Oral tegafur/uracil (28) Excluded ( 82 Oral linolenic acid (31) Excluded (2) Placebo (31) NOTE. Fourteen RCTs were included in the meta-analysis.…”

Section: Meta-analysismentioning

confidence: 99%

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

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There is no standard treatment for patients with unresectable hepatocellular carcinoma (HCC). Survival benefits derived from medical interventions are controversial. The aim of this systematic review was to assess the evidence of the impact of medical treatments on survival. Randomized controlled trials (RCTs) that were published as full papers assessing survival for primary treatments of HCC were included. MEDLINE, the Cochrane Library, CANCERLIT, and a manual search from 1978 to May 2002 were used. The primary end point was survival, and the secondary end point was response to treatment. Estimates of effect were calculated according to the random effects model. Sensitivity analysis included methodological quality. We identified 61 randomized trials, but only 14 met the criteria to perform a meta-analysis assessing arterial embolization (7 trials, 545 patients) or tamoxifen T he incidence of hepatocellular carcinoma (HCC) is increasing worldwide. 1 Liver cancer is the fifth most common cancer in the world and the third most common cause of cancer-related death. 2 Cohort studies and cost-efficiency modeling have suggested that surveillance of well-defined cirrhotic patients may decrease tumor-related mortality. However, only 30% of patients benefit from curative therapies such as resection, transplantation, or percutaneous ablation 3 and achieve 5-year survival rates of 50% to 75%. 4 Most patients with HCC are diagnosed at intermediate to advanced stages, and there is no standard treatment for these patients. 3,4 The most reliable method to show survival advantages is to perform large randomized controlled trials (RCTs) that include more than 1,000 patients comparing treatment versus no treatment in a well-defined strata of individuals. 5-10 These investigations are lacking in patients with HCC. On the contrary, several medical interventions have been tested in the setting of small RCTs. However, the reduced size of these studies may cause questions of their statistical power when detecting survival differences, which, as in many areas of health care and oncology, are unlikely to be large. This raises the need for a systematic meta-analysis assessment, with a major role to integrate valid information and provide estimates of treatment effects when RCTs themselves are not of sufficient size. 9,10 Two systematic reviews published years ago 11,12 suggested a potential benefit for at Abbreviations: HCC, hepatocellular carcinoma; RCT, randomized controlled trial; OR, odds ratio; CI, confidence interval.

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Section: Meta-analysismentioning

confidence: 99%

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

2003

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“…In patients with advanced HCC or extrahepatic metastasis, chemotherapy is mostly performed and its usefulness has been shown [1][2][3][4][5] . However, in patients with stageⅠor Ⅱ HCC, including early-stage HCC, percutaneous therapy is useful because its impact on normal hepatocytes is relatively small.…”

Section: Ablation Therapy For Hccmentioning

confidence: 99%

Secondary prevention of recurrence by interferon therapy after ablation therapy for hepatocellular carcinoma in chronic hepatitis C patients

Ishikawa¹

2008

WJG

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“…Retinoids (24) and Interferon (25,26) have also been used as an adjuvant therapy to prevent the development of tumors, but the value of these treatments is not widely accepted in spite of recent promising results. UFT has been reported to be effective against HCC (27)(28)(29) and to have an antiangiogenic function (15,30). We therefore expected that it would prevent recurrence after embolization.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy with tegafur/uracil administration after transcatheter arterial chemoembolization for advanced hepatocellular carcinoma

Ueda¹,

Tanaka²,

Kida³

et al. 2008

Oncol Rep

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Abstract. Although transcatheter arterial chemoembolization (TACE) is considered to be an effective treatment for advanced hepatocellular carcinoma (HCC), it is difficult to achieve complete necrosis by TACE alone due to incomplete embolization and tumor angiogenesis. Recent studies have shown that tegafur/uracil (UFT ® ) inhibits tumor angiogenesis in several cancer types. Therefore, this study was conducted to test the efficacy and toxicity of the UFT administration after TACE in advanced HCC. Thirty patients with HCC who had been treated with TACE alone more than three times and had a recurrence within 6 months were enrolled. All of the patients were treated with TACE and 28 patients were randomly assigned to the UFT (UFT 300 mg/day, three days after TACE, n=14) and control groups (n=14). The primary end point was the time to treatment failure (TTF) and the secondary end points were mainly the response rate and toxicity. Administration and observation were continued up to 6 months after TACE unless local recurrence was detected or serious adverse events developed. The median TTF in the control group was 87 days, whereas in the UFT group it was 127 days, thus significantly prolonged as compared to the control group (P=0.0016). Moreover, the overall response rate (35.7%) in the UFT group was significantly higher than that in the control group (0%). As for toxicity, only 4 patients in the UFT group developed grade 1-2 toxicities such as ascites. Serious complications by TACE were not observed in either group. Notably, there were no increases in the serum VEGF levels in the UFT group whereas those in the control group increased significantly. In conclusion, UFT administration after TACE was an effective treatment and showed no severe adverse events. This regimen may have an adjuvant role and antiangiogenic function in advanced HCC.

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Improved survival with oral administration of enteric‐coated tegafur/uracil for advanced stage IV‐A hepatocellular carcinoma

Abstract: Although the prognosis of most patients with stage IV-A HCC is poor, administration of enteric-coated tegafur/uracil induces long-term survival and is an effective treatment for stage IV-A HCC.

Cited by 58 publications

References 14 publications

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

Secondary prevention of recurrence by interferon therapy after ablation therapy for hepatocellular carcinoma in chronic hepatitis C patients

Adjuvant chemotherapy with tegafur/uracil administration after transcatheter arterial chemoembolization for advanced hepatocellular carcinoma

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