Korean J Hepatol.  2012 Mar;18(1):32-40. 10.3350/kjhep.2012.18.1.32.

Efficacy and safety of metronomic chemotherapy for patients with advanced primary hepatocellular carcinoma with major portal vein tumor thrombosis

• Woo HY
• Youn JM
• Bae SH
• Jang JW
• Cha JH
• Kim HL
• Chun HJ
• Choi BG
• Choi JY
• Yoon SK

• KMID: 1372649
• DOI: http://doi.org/10.3350/kjhep.2012.18.1.32

Abstract

BACKGROUND/AIMS
Low-dose metronomic chemotherapy involves the frequent administration of comparatively low doses of cytotoxic agents with no extended breaks, and it may be as efficient as and less toxic than the conventional maximum tolerated dose therapy. This study evaluated the feasibility and therapeutic efficacy of metronomic chemotherapy in patients with advanced hepatocellular carcinoma (HCC) with major portal vein thrombosis (PVT).
METHODS
Thirty consecutive HCC patients with major PVT with or without extrahepatic metastasis were prospectively allocated to metronomic chemotherapy consisting of epirubicin being infused through the correct hepatic artery at a dose of 30 mg/body surface area (BSA) every 4 weeks, and cisplatin (15 mg/BSA) and 5-fluorouracil (50 mg/BSA) every week for 3 weeks, with intervening 1 week breaks. The treatment response was assessed using response evaluation criteria in solid tumors (RECIST).
RESULTS
In total, 116 cycles of metronomic chemotherapy were administered to the 30 patients, with a median of 3 cycles given to individual patients (range, 1-15 cycles). Six patients (20.0%) achieved a partial response and six patients (20.0%) had stable disease. The median time to disease progression and overall survival were 63 days (range, 26-631 days) and 162 days (95% confidence interval; range, 62-262 days), respectively. Overall survival was significantly associated with baseline alpha-fetoprotein level (P=0.001) and tumor response (P=0.005). The baseline alpha-fetoprotein level was significantly associated with the disease control rate (P=0.007). Adverse events were tolerable and managed successfully with conservative treatment.
CONCLUSIONS
Metronomic chemotherapy may be a safe and useful palliative treatment in HCC patients with major PVT.

Keyword

Hepatocellular carcinoma; Metronomic chemotherapy; Cisplatin; 5-Fluorouracil

MeSH Terms

Administration, Metronomic
Adult
Aged
Antineoplastic Agents/administration & dosage
Carcinoma, Hepatocellular/complications/*drug therapy/mortality
Cisplatin/administration & dosage
Epirubicin/administration & dosage
Female
Fluorouracil/administration & dosage
Humans
Kaplan-Meier Estimate
Liver Neoplasms/complications/*drug therapy/mortality
Male
Middle Aged
*Portal Vein
Prognosis
Tomography, X-Ray Computed
Venous Thrombosis/complications/*diagnosis
alpha-Fetoproteins/analysis