Prevention of intrahepatic distant recurrence by transcatheter arterial infusion chemotherapy with platinum agents for stage I/II hepatocellular carcinoma

Abstract

BACKGROUND:The effectiveness of additional chemotherapy in preventing intrahepatic distant tumor recurrence of hepatocellular carcinoma (HCC) has not been fully established. The authors compared the efficacy of 2 platinumbased chemotherapeutic agents in combination with radical local treatment for preventing intrahepatic distant recurrence (IDR). METHODS: Seventy-eight patients with stage I/II HCC aged 45 to 85 years underwent transcatheter arterial chemoembolization and/or radiofrequency ablation after they received hepatic arterial infusion (HAI) of platinum compounds. The HAI consisted of cis-diammine(1,1-cyclobutanedicarboxylato)platinum(II) (carboplatin) in 25 patients and cis-diamminedichloroplatinum (II) (cisplatin) in 53 patients. Multivariate analysis was used to identify independent factors that were associated with IDR. RESULTS: Cumulative IDR rates at 1 year, 2 years, and 3 years were 21.7%, 52.2% and 75.7%, respectively, in the carboplatin group and 8.1%, 22.7%, and 36.9%, respectively, in the cisplatin group. The cisplatin group had a significantly lower IDR rate compared with the carboplatin group. The selection of a platinum agent was 1 of the independent factors for IDR in a multivariate Cox proportional hazards model. CONCLUSIONS: HAI chemotherapy with cisplatin before radical local treatment was effective in patients with HCC. The authors concluded that radical local treatment with concurrent HAI using cisplatin may contribute to a longer progression-free period, which could be predicted with intrahepatic imaging in patients with stage I/II HCC.

Improved survival with double platinum therapy transcatheter arterial infusion using cisplatin and transcatheter arterial chemoembolization using miriplatin for BCLC-B hepatocellular carcinoma

“…When we investigated the effect of the addition of TAI with DDP-H and carboplatin as pretreatment prior to TACE/radiofrequency ablation therapy as radical local treatment for stage I/II HCC, we reported that whole-liver TAI using DDP-H significantly inhibited intrahepatic recurrence (9). In addition, in patients with JIS 0–1 stage HCC, survival was significantly prolonged in the group that received whole-liver TAI with DDP-H compared with the group that did not undergo infusion, and the results of the multivariate analyses demonstrated that performing whole-liver TAI with DDP-H was a factor contributing to improved survival (10).…”

“…We previously reported that whole-liver transcatheter arterial infusion (TAI) with a high concentration of a fine-powder formulation of cisplatin (DDP-H) (IA-call ® ; Nippon Kayaku Co. Ltd., Tokyo, Japan) prior to radical local treatment inhibited intrahepatic recurrence of HCC (9), and that whole-liver TAI of DDP-H administered to HCC patients with a Japan Integrated Staging (JIS) score of 0–1 improved survival (10). …”

Treatment Strategy for Recurrent Multiple Hepatocellular Carcinoma

“…While intra-arterial chemotherapy is not highly appreciated in the West, hepatic arterial infusion resulting in high local drug concentrations is expected to improve the prognosis and prevent recurrence, because lesions are often localized to the liver even in the advanced stage of HCC, and various regimens have been attempted without reaching consensus on the administration method or dose level. We evaluated the effectiveness of additional chemotherapy of the platinum-containing drugs carboplatin (CBDCA) and DDP-H in preventing intrahepatic distant tumor recurrence [16]. A total of 78 patients with a diagnosis of primary stage I/II HCC who underwent TACE and RFA after whole liver arterial infusion of CBDCA (25 patients) or DDP-H (53 patients) for local control and recurrence prevention were followed up on a long-term basis, and the clinical background factors, intrahepatic distant tumor recurrence rate, and intrahepatic distant tumor recurrence factors were compared between the CBDCA and DDP-H groups.…”

Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma in Japan

“…There is one report that RFA with sequential HAIC using cisplatin contributed to a longer disease-free interval [16]. HAIC using cisplatin before RFA might prevent an increase in the size of pre-existing microscopic tumor foci.…”

“…However, in cases in which extrahepatic spread is minimal and local control of liver tumors is considered more important, HAIC is useful and may offer survival benefits, even when there are extrahepatic metastases. HAIC has often been used in these cases in Japan [16,17]. …”