Metronomic capecitabine vs. best supportive care in Child-Pugh B hepatocellular carcinoma: a proof of concept

Abstract

There is a relative lack of evidence about systemic treatments in patients with hepatocellular carcinoma (HCC) and moderate liver dysfunction (Child-Pugh B). In this multicenter study we retrospectively analyzed data from Child-Pugh B-HCC patients naïve to systemic therapies, treated with MC or best supportive care (BSC). To reduce the risk of selection bias, an inverse probability of treatment weighting approach was adopted. Propensity score was generated including: extrahepatic spread; macrovascular invasion; performance status, alphafetoprotein > 400 ng/ml, Child- Pugh score [B7 vs. B8–9]. We identified 35 MC-treated patients and 70 controls. Median overall survival was 7.5 [95% CI: 3.733–11.267]in MC-patients and 5.1 months [95% CI: 4.098–6.102] in the BSC group (p = 0.013). In patients treated with MC, median progression-free survival was 4.5 months (95% CI: 2.5–6.5). The univariate unweighted Cox regression showed a 42% reduction in death risk for patients on MC (95%CI: 0.370–0.906; p = 0.017). After weighting for potential confounders, death risk remained essentially unaltered. In the MC group, 12 patients (34.3%) experienced at least one adverse event, the most common of which were: fatigue (17.1%), hand-foot syndrome (8.5%), thrombocytopenia (8.5%), and neutropenia (5.7%). MC seems a safe option for Child-Pugh B-HCC patients. Its potential antitumour activity warrants prospective evaluations.

Namodenoson in Advanced Hepatocellular Carcinoma and Child–Pugh B Cirrhosis: Randomized Placebo-Controlled Clinical Trial

“…For example, a real-world cohort study and a case series investigating nivolumab in HCC CBP patients (including 71 and 18 such patients, respectively, mostly in the second-line setting) demonstrated CR rates of 0% and 6%, respectively, and PR rates of 3% and 11%, respectively [ 19 , 20 ]. Metronomic capecitabine (MC) treatment (i.e., chronic administration of capecitabine at low doses without prolonged drug-free breaks) also showed promising results in two retrospective studies of which only one included only HCC CBP patients [ 21 , 22 ]. This retrospective analysis compared MC ( n = 35) to best supportive care (BSC; n = 70) in treatment-naïve CPB patients and demonstrated significantly improved OS with MC vs. BSC (7.5 vs. 5.1 months; p = 0.013) [ 21 ].…”

Circulating Tumor DNA in Biliary Tract Cancer: Current Evidence and Future Perspectives

“…Although the anatomical classification of BTC may be considered simplistic, it faithfully reflects the differentiation of BTC subgroups in terms of epidemiology, etiology, clinical presentation, molecular features and therapeutic approaches (6,7). BTC currently represents about 3% of all gastrointestinal malignancies and the second most common primary liver cancer (PLC), following hepatocellular carcinoma (HCC) (8,9). Even though BTC is considered an uncommon cancer in Western countries, its incidence is increasing, and perhaps is associated with the increasing incidence of iCCA and partly as a result of better disease recognition (10)(11)(12).…”

CyberKnife Stereotactic Body Radiation Therapy as an Effective Treatment for Hepatocellular Carcinoma Patients With Decompensated Cirrhosis

“…Generally, based on chronic hepatitis B or C virus infection in China, HCC patient treatments were limited not only by advanced or end stage at diagnosis but also by poor liver function. Previous studies (13)(14)(15) have shown that poor Child-Pugh scores affect not only choice of treatment but also the prognosis of HCC patients. Decompensated liver cirrhosis patients may be more at risk of dying from cirrhosis complications than from tumor dissemination.…”