Intra-arterial and Intravenous Use of 4′ Epidoxorubicin Combined with 5-Fluorouracil in Primary Hepatocellular Carcinoma

Kajanti, Mikael; Pyrhönen, Seppo; Mäntylä, M; Rissanen, P

doi:10.1097/00000421-199202000-00008

Cited by 39 publications

(23 citation statements)

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“…Therefore, further studies should be published to ensure a solid assessment, mainly in reference to therapies with acceptable response rates, such as internal radiation [54][55][56] or arterial chemotherapy. [44][45][46][47][48][49][50] In summary, the present systematic review provides consistent evidence that arterial chemoembolization may benefit a subset of patients with unresectable HCC and thus proposes this therapy as the standard intervention in these cases. The data are relevant for the decision-making process of these patients, who at present do not have any option for cure.…”

Section: Discussionsupporting

confidence: 63%

“…Lin et al (Gastroenterology, 1988) 27 Embolization (21 40 Embolization (20) Excluded ( 44 Arterial chemotherapy (epidoxorubicin ϩ 5-FU) (10) Excluded (1) IV epidoxorubicin ϩ 5-FU (10) 24. Ikeda et al (Cancer Chemother Pharmacol, 1992) 45 Arterial lipiodolization (ADMOS) (59) Excluded ( 46 Arterial chemotherapy (ADM ϩ CDPP ϩ oral 5-FU (15) Excluded ( 69 IV doxorubicin (n ϭ 21) Excluded (1) IV VP 16 (n ϭ 14) 49.…”

Section: Selection Of Trialsmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 63%

Section: Selection Of Trialsmentioning

confidence: 99%

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

2003

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“…No definite improvement was observed following hepatic intra-arterial infusion at 40 to 90 mg/m 2 every 3-4 weeks [90].…”

Section: -15 7-18mentioning

confidence: 89%

Drugs ten years later: Epirubicin

Bonadonna¹,

Gianni²,

Santoro³

et al. 1993

Annals of Oncology

144

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“…In the present protocol, interferon was administered at 9.00 a.m. on day 1, followed by CDDP 4 h later, and 5-FU 1.5 h after that. 5-FU is known to be a time-dependent agent, however, it was administered through an intra-arterial route as a bolus manner [45] to give all drugs in a day. These intervals and these administration methods were thought to provide sufficient conditions for cell metabolism in the cancer tissue to undergo changes induced by the prior administration of IFN.…”

Section: Discussionmentioning

confidence: 99%

Clinical Pilot Study of Intrahepatic Arterial Chemotherapy with Methotrexate, 5-Fluorouracil, Cisplatin and Subcutaneous Interferon-Alpha-2b for Patients with Locally Advanced Hepatocellular Carcinoma

et al. 1997

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To evaluate the efficacy of methotrexate (MTX)-5-fluorouracil (5-FU), cisplatin (CDDP), and interferon-α-2b(IFNα-2b) combination therapy, we conducted a clinical pilot study in patients with locally advanced hepatocellular carcinoma (HCC). Sixteen patients, who had received no prior treatment for the HCC, with portal tumor thrombosis in the main trunk or in the major branch were enrolled in the study. IFNα-2b (3 × 10⁶ units) was injected subcutaneously 3 times per week. After a bolus administration of MTX (30 mg/m²), CDDP (75 mg/m²) and thereafter 5-FU (750 mg/m²) were given weekly by intrahepatic arterial infusion. In 15 eligible patients, there were 1 complete response (CR) and 6 partial responses (PR) with a response rate of 46.7%. Median survival of the 15 patients was 7 months, and the 2-year survival rate of CR and PR patients was 57.1%. There was severe transient hematologic toxicity. More than grade 2 nausea/vomiting was noted in >50%. In conclusion, the IFNα-2b combination chemotherapy demonstrated good response in patients with locally advanced HCC. This treatment should be tried in a controlled study.

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Intra-arterial and Intravenous Use of 4′ Epidoxorubicin Combined with 5-Fluorouracil in Primary Hepatocellular Carcinoma

Cited by 39 publications

References 0 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

Drugs ten years later: Epirubicin

Clinical Pilot Study of Intrahepatic Arterial Chemotherapy with Methotrexate, 5-Fluorouracil, Cisplatin and Subcutaneous Interferon-Alpha-2b for Patients with Locally Advanced Hepatocellular Carcinoma

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