Clin Mol Hepatol.  2013 Sep;19(3):288-299. 10.3350/cmh.2013.19.3.288.

Efficacy and safety of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma as first-line therapy

• Oh MJ
• Lee HJ
• Lee SH

• KMID: 1705207
• DOI: http://doi.org/10.3350/cmh.2013.19.3.288

Abstract

BACKGROUND/AIMS
Hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and cisplatin for intractable advanced hepatocellular carcinoma (HCC) may have survival benefits. We aimed to determine the efficacy and safety of HAIC for advanced HCC as first-line therapy.
METHODS
A total of 54 patients who received only HAIC with 5-fluorouracil (750 mg/m2 on days 1-4) and cisplatin (25 mg/m2 on days 1-4) for advanced HCC from Jan. 2009 to Dec. 2011 were selected. According to Child-Pugh class, the overall survival (OS), progression-free survival (PFS), and adverse events after HAIC were investigated retrospectively.
RESULTS
Median OS and PFS between the Child-Pugh A group (n=24) and the Child-Pugh B/C group (n=30) were 8.7 (95% confidence interval [CI]: 4.7-12.7) vs. 3.7 months (95% CI: 2.0-5.3), and 7.1 (95% CI: 3.8-10.4) vs. 3.6 months (95% CI: 2.0-5.2), respectively. Although median OS and PFS were not statistically significant between the two groups (P=0.079, P=0.196), the Child-Pugh class B/C tended to influence poor OS. Serious adverse events > or = grade 3 occurred frequently in both groups (83.3 vs. 96.7%, P=0.159). Responders (22.2%, complete or partial response) significantly differed in median OS, compared to non-responders (13.1 vs. 4.4 months, P=0.019). Achievement of complete or partial response was an independent prognostic factor of OS (hazard ratio: 0.4, 95% CI: 0.2-0.8, P=0.011).
CONCLUSIONS
Achievement of response after HAIC provide a survival benefit in patients with advanced HCC, but HAIC should be administered cautiously in patients with Child-Pugh class B/C, because of a relatively low survival and high incidence of serious adverse events.

Keyword

Carcinoma, Hepatocellular; Hepatic arterial infusion chemotherapy; Child-Pugh class; Overall survival; Progression-free survival

MeSH Terms

Adult
Aged
Anemia/etiology
Antineoplastic Agents/adverse effects/*therapeutic use
Carcinoma, Hepatocellular/*drug therapy
Cisplatin/adverse effects/*therapeutic use
Diarrhea/etiology
Disease-Free Survival
Drug Therapy, Combination
Female
Fluorouracil/adverse effects/*therapeutic use
Humans
Infusions, Intra-Arterial
Kaplan-Meier Estimate
Liver Neoplasms/*drug therapy
Male
Middle Aged
Neutropenia/etiology
Retrospective Studies
Severity of Illness Index
Thrombocytopenia/etiology
Treatment Outcome
Antineoplastic Agents
Cisplatin
Fluorouracil