Repetitive short‐course hepatic arterial infusion chemotherapy with high‐dose 5‐fluorouracil and cisplatin in patients with advanced hepatocellular carcinoma

Abstract

BACKGROUND. Hepatic arterial infusion chemotherapy (HAIC) has often been selected as a therapeutic option for patients with advanced hepatocellular carcinoma (HCC). The objective of the current study was to evaluate the efficacy and safety of repetitive HAIC with high‐dose 5‐fluorouracil (5‐FU) and cisplatin given for 3 days in patients with advanced HCC. METHODS. Between January 2001 and December 2004, a total of 41 patients with unresectable advanced HCC were enrolled. The patients underwent HAIC via the implantable port system with 5‐FU (at a dose of 500 mg/m2 on Days 1–3) and cisplatin (at a dose of 60 mg/m2 on Day 2) every 4 weeks. Tumor response was assessed at the end of every 3 cycles. RESULTS. The median age of the patients was 53 years and 34 patients (82.9%) had evidence of portal vein thrombosis. In total, 230 cycles of HAIC were administered to the 41 patients, with a median of 6 cycles given (range, 1–14 cycles). Nine patients (22.0%) achieved a partial response and 14 patients (34.1%) had stable disease. The median time to disease progression and overall survival were 7.0 months and 12.0 months, respectively. The overall survival was found to be significantly longer in the successful disease control group (patients with a complete response, partial response, and stable disease) than in the disease progression group (median of 14.0 months vs 6.0 months; P < .001). Adverse reactions were tolerable and successfully managed with conservative treatment. CONCLUSIONS. HAIC with high‐dose 5‐FU and cisplatin given for 3 days achieved effective and safe results in patients with advanced HCC. Therefore, repetitive short‐course HAIC with high‐dose 5‐FU and cisplatin may be useful as an alternative therapeutic option for patients with advanced HCC. Cancer 2007. © 2007 American Cancer Society.

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

“…These response and disease control rates are significantly higher than those with sorafenib treatment [5,29] . Several studies reported that the therapeutic effectiveness of HAIC was an important prognostic factor [10,11,30] , which is consistent with our results. In the present study, the median OS of the disease control group after two cycles of HAIC was significantly longer than patients showing PD.…”

“…However, the ECF regimen appears to be more toxic than in previous reports of high-dose HAIC [10,14] . While grade 3 hematologic or non-hematologic toxicities comprised less than 5% in previous studies, grade 3 leukopenia, anemia, and thrombocytopenia in this study comprised 8%, 26% and 44% of the toxicities, respectively, and hepatic toxicity was higher.…”

“…Ando et al [11] reported that HAIC using low-dose cisplatin and 5-FU demonstrated a good response rate and survival time in 48 patients with PVTT. Park et al [10] showed that repetitive HAIC with high-dose 5-FU and cisplatin given for 3 d was effective and safe. In Japan, interferon-combined HAIC is also commonly used.…”

“…HAIC enables anti-cancer agents to be delivered locally at high concentrations to hypervascular tumors, thereby keeping systemic concentrations of chemotherapeutic agents low due to the first-pass effect [10] . Many studies using HAIC have reported that it is a useful modality for patients with advanced HCC [10][11][12][13][14] . However, there are limited data defining the clinical factors predicting its efficacy.…”

Sorafenib and hepatic arterial infusion chemotherapy for unresectable advanced hepatocellular carcinoma: A comparative study

“…These patients included 45 treated with HAIC and 20 treated with sorafenib. All 65 patients had advanced HCC unsuitable for surgical resection, liver transplantation, or nonsurgical interventions [such as radiofrequency ablation or transcatheter arterial chemoembolization (TACE)] because of multiple tumors involving both lobes of the liver or portal invasion in the first or main portal branch (19). Other eligibility criteria included Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 for sorafenib or 0 to 2 for HAIC, no other serious medical condition, no history of systematic chemotherapy with sorafenib, no concurrent malignancy of another type, and previously described laboratory findings for sorafenib (20).…”