Therapeutic Strategy of Advanced Hepatocellular Carcinoma by Using Combined Intra-Arterial Chemotherapy

Abstract

The majority of primary liver cancer is hepatocellular carcinoma (HCC). HCC has increased in many countries, particularly where hepatitis C virus infection is more common than hepatitis B virus infection. Several non-surgical treatment options, including transcatheter arterial embolization, percutaneous ethanol injection, microwave coagulation, and radiofrequency ablation have been developed and are widely used for unresectable HCC. However, these modalities are not indicated for patients with multifocal disease, invasion or thrombosis of major blood vessels, and poor liver function. The majority of patients with advanced hepatocellular carcinoma (aHCC) do not survive for longer than 6 months from the time of diagnosis. Combined intra-arterial chemotherapy is one of the few remaining options for patients with aHCC. Continuous local arterial infusion of 5-fluorouracil (5-FU) and cisplatin (CDDP) via an infuser pump and implanted reservoir has been shown to prolong the survival of patients with aHCC. When LC patients with aHCC undergo chemotherapy, we should consider the influence of both tumor factors and host immunity. This review focuses on therapeutic strategy of patients with aHCC by using combined intra-arterial chemotherapy and the influence of host immunity on the response to such chemotherapy based on our results. The present article shows some recent patents related to the field.

Clinicopathological significance of RASSF1A reduced expression and hypermethylation in hepatocellular carcinoma

“…The prognosis of patients with HCC has marginally improved over the last two decades, but the 5-year survival rate is still not optimistic [1,2]. This dismal result is in part due to the fact that diagnosis is frequently made at an advanced tumor stage precluding effective treatment.…”

“…Although the prognosis of patients with HCC has marginally improved over the last two decades, the 5-year survival rate still remains poor, currently 5%, due to the late diagnosis. The majority of patients with advanced hepatocellular carcinoma do not survive for longer than 6 months from the time of diagnosis [2]. The Ras association domain family 1A (RASSF1A) gene is located in chromosome 3p21.3 [3].…”

Importance of branched-chain amino acids in patients with liver cirrhosis and advanced hepatocellular carcinoma receiving hepatic arterial infusion chemotherapy

“…HAIC with 5-fluorouracil (5-FU) and cisplatin (CDDP) using an infuser pump and an implanted reservoir has been related to prolong the survival of aHCC patients [6][7][8]. We have also reported that combined intra-arterial therapy with lowdose 5-FU, CDDP, and leucovorin (LV) prolongs the survival of aHCC patients [9]. Moreover, we have shown that continuous intra-arterial infusion for 24 h is more effective than infusion for 6 h in patients with HCV-related LC and aHCC, although 24-h infusion also causes stronger hematologic toxicity [10].…”

Emergence of IFN-lambda as a Potential Antitumor Agent

“…However TACE is rarely curative, and progression-free survival beyond 24 months is not frequent (Georgiades et al, 2008;Lau and Lai, 2008). For patients with advanced disease, systemic chemotherapy is of limited benefit because of the resistance of HCC to existing anticancer drugs and the fact that about 50% of patients with HCC die secondary to liver failure from cirrhosis (Di Bisceglie et al, 1998;Nagai and Sumino, 2008). HCC occurs most frequently in patients with cirrhosis as a result of chronic HBV and HCV infections, and alcohol abuse (El-Serag, 2002;Sherman, 2005).…”