A randomized prospective trial comparing full dose chemotherapy to 131I antiferritin: An RTOG study

Order, Stanley E.; Pajak, Thomas; Leib, Steven; Asbell, Sucha O.; Leichner, Peter K.; Ettinger, David S.; Stillwagon, Gary B.; Herpst, Jeffrey; Haulk, Tom; Kopher, K; Frazier, Chester N.; Klein, Jerry L.

doi:10.1016/0360-3016(91)90191-6

Cited by 49 publications

(12 citation statements)

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“…This difference could not be attributed to differences in toxicity profile or to larger tumour burden or cirrhosis. A similar phenomenon was described earlier by Order et al [16] and Patt et al [17], who reported significantly higher response rates to systemic chemotherapy in patients who had low levels of AFP. Patt et al [17] suggested that the better response to 5-fluorouracil of patients with low serum AFP may be due to lower expression of thymidylate synthase, making the tumour more sensitive to fluoropyrimidines.…”

Section: Discussionsupporting

confidence: 69%

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Systemic Chemotherapy with Epirubicin for Treatment of Advanced or Multifocal Hepatocellular Carcinoma

et al. 2001

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Background: The purpose of this retrospective study was to determine the response rate and effect on survival of chemotherapy with epirubicin in non-resectable advanced hepatocellular carcinoma (HCC). Methods: Fifty-two patients with non-resectable disease were treated with epirubicin. A treatment cycle consisted of 20 mg/m² i.v. on days 1, 8 and 15 and was repeated every 4 weeks to a maximum dose of 1,000 mg/m². Forty-four patients were eligible for analysis. Results: Out of 44 patients, 1 (2.3%) achieved a complete response, 3 (6.8%) had partial responses and 16 (36%) had stable disease (SD). For patients with successful disease control (complete and partial responders and patients with SD), the median survival was 16.2 months; for non-responders, it was 6.1 months (p < 0.003). Eight (88.9%) of 9 patients with alpha-fetoprotein (AFP) levels <50 µg/l achieved successful disease control compared to 12 (34.9%) out of 35 patients with initially elevated AFP (p < 0.0001). Conclusion: Epirubicin appears to be an active therapeutic option for patients with non-resectable HCC. Especially the subgroup of patients with low levels of AFP may benefit from this treatment.

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Section: Discussionsupporting

confidence: 69%

“…The overall median survival was 13.7 months (range 2-39 months). The patient with a CR survived 16 fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Systemic Chemotherapy with Epirubicin for Treatment of Advanced or Multifocal Hepatocellular Carcinoma

et al. 2001

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“…Although meta-analysis is technically possible, it is not clinically sound and the potential bias in the estimates of treatment effect may not be properly controlled. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…These trials are summarized in Table 4. [82][83][84][85][86][87][88][89][90][91] Both complete and partial remissions have been achieved. Some unresectable tumors have also become resectable.…”

Section: Parenteral Infusion Of Radiolabeled Antibodiesmentioning

confidence: 99%

Internal radiation therapy for patients with primary or metastatic hepatic cancer

Ho¹,

Lau²,

Leung³

et al. 1998

Cancer

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A randomized prospective trial comparing full dose chemotherapy to 131I antiferritin: An RTOG study

Cited by 49 publications

References 18 publications

Systemic Chemotherapy with Epirubicin for Treatment of Advanced or Multifocal Hepatocellular Carcinoma

Systemic Chemotherapy with Epirubicin for Treatment of Advanced or Multifocal Hepatocellular Carcinoma

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

Internal radiation therapy for patients with primary or metastatic hepatic cancer

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