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

Abstract

AIM:To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis. METHODS:Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m 2 epirubicin on day 1, 60 mg/m 2 cisplatin for 2 h on day 2, and 500 mg/m 2 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk. RESULTS:Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD).The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm 3 (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-Ⅱ (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and α-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed. CONCLUSION: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm 3 and good prognostic factors.© 2013 Baishideng. All rights reserved. Key words: Hepatocellular carcinoma; Hepatic arterial infusion chemotherapy; Portal vein tumor thrombosisCore tip: The aim of this study was to investigate the prognostic factors of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma patients with portal vein tumor thrombosis. The primary findings of this study were as follows: (1) The median survival and time to progression were 7 and 2 mo, respectively; (2) A tumor volume of < 400 cm 3 and protein induced by vitamin K absence or antagonist-Ⅱ were independent pre-treatment prognostic factors; (3) Disease control and ≥ 50% tumor marker reduction were significant prognostic factors after the second cycle of hepatic arterial infusion chemotherapy (HAIC); and (4) Objective tumor response, disease control and portal vein tumor thrombosis response were independent post-treatment prognostic factors at the end of the HAIC. ORIGINAL ARTICLE

Hepatic Resection for Hepatocellular Carcinoma with Tumor Thrombus in the Major Portal Vein

“…A recent report of HAIC monotherapy found complete and partial response rates of 4 and 36.5%, respectively, in 476 patients with advanced HCC including portal vein invasion [12] . In reports of approximately 50 HCC patients with PVTT, 6-8% of patients achieved a complete response, and 32-48% of patients had a partial or complete response [13,14] . The relatively high response rate to HAIC indicates that it may be more potent than sorafenib, despite any evidence of effectiveness.…”

“…However, HAIC was effective in a subset of patients, resulting in a complete response in 4-8% of patients, and an overall response rate (including complete and partial responses) of approximately 40% in patients with advanced HCC with portal vein invasion [12][13][14] . No complete responses and a small number of partial responses were reported in the 2-phase III sorafenib trials [7,15] .…”

“…No complete responses and a small number of partial responses were reported in the 2-phase III sorafenib trials [7,15] . On the other hand, HAIC has a relatively high response rate [12][13][14] . Curative hepatic resection, which can be considered to indicate a complete response, is an important curative option for HCC with PVTT, and HAIC is a potent treatment option.…”

Clinical effects and safety of intra‑arterial infusion therapy of cisplatin suspension in lipiodol combined with 5‑fluorouracil versus sorafenib, for advanced hepatocellular carcinoma with macroscopic vascular invasion without extra‑hepatic spread: A prospective cohort study

“…PVTT often leads to extensive spreading of the tumor and can increase portal venous blood pressure, resulting in the fatal rupture of esophageal varices (33). PVTT can also decrease portal flow that may lead to ascites, jaundice, hepatic encephalopathy, or liver failure (33). Therefore, the presence of PVTT is one of the most significant prognostic factors of poor outcome (34,35), and it has been reported that these patients survive only 2.7-4 months if left untreated (35,36).…”

“…PVTT often leads to extensive spreading of the tumor and can increase portal venous blood pressure, resulting in the fatal rupture of esophageal varices (33). PVTT can also decrease portal flow that may lead to ascites, jaundice, hepatic encephalopathy, or liver failure (33).…”