Brief Article
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World J Gastroenterol. Jan 7, 2014; 20(1): 235-241
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.235
Epirubicin, Cisplatin, 5-FU combination chemotherapy in sorafenib-refractory metastatic hepatocellular carcinoma
Ji Eun Lee, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Young Kyoung You, Myung Ah Lee
Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea
Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Division of Hepatology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea
Ji Eun Lee, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon, Myung Ah Lee, Department of Internal Medicine, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea
Young Kyoung You, Department of Surgery, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea
Author contributions: Lee JE and Lee MA designed, analyzed and wrote this manuscript; Bae SH, Choi JY, Yoon SK and You YK enrolled the patients, collected data and reviewed the manuscript; all authors approved the final revised the manuscript.
Correspondence to: Myung Ah Lee, MD, PhD, Department of Internal Medicine, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-040, South Korea. angelamd@catholic.ac.kr
Telephone: +82-2-22586044 Fax: +82-2-5993589
Received: June 28, 2013
Revised: October 9, 2013
Accepted: October 19, 2013
Published online: January 7, 2014
Processing time: 205 Days and 23.2 Hours
Abstract

AIM: To evaluate the clinical efficacy and safety of epirubicin, cisplatin, and 5-FU combination chemotherapy for the sorafenib-refractory metastatic hepatocellular carcinoma (HCC).

METHODS: From April 2009 to June 2012, 31 patients who were diagnosed with metastatic and progressive HCC after sorafenib treatment were retrospectively reviewed. Patients were treated with the combination of epirubicin (50 mg/m2 IV; day 1), cisplatin (60 mg/m2 IV; day 1), and 5-FU (1000 mg/m2 IV; day 1-3) [Epirubicin, cisplatin, 5-FU combination (ECF)], repeated every 4 wk.

RESULTS: The overall response rate was 12.9%. Patients who responded to ECF chemotherapy showed a longer overall survival (OS) and time to progression (TTP) relative to those in the non-responder group (OS: 20.4 mo vs 4.9 mo, P < 0.001, TTP: 9.4 mo vs 2.2 mo, P < 0.001). Patients with a stable primary liver mass also exhibited a longer OS and TTP relative to those with progressive disease (OS: 13.4 mo vs 5.3 mo, P = 0.003; TTP: 9.4 mo vs 2.3 mo, P = 0.003). The most common hematologic toxicity was thrombocytopenia (87.2%), and the incidence of grade 3-4 neutropenia was 53.9%. Age older than 60, a stable primary mass, and a good response to chemotherapy were prognostic factors for OS and TTP.

CONCLUSION: This combination cytotoxic chemotherapy can serve as another treatment option after sorafenib failure for the subset of patients with advanced metastatic HCC.

Keywords: Hepatocellular carcinoma; Sorafenib; Epirubicin; Cisplatin; 5-FU

Core tip: For advanced and metastatic hepatocellular carcinoma (HCC), sorafenib has been used as the standard systemic treatment. However, after failure to treat with sorafenib, no effective therapy is available. In the present study, we suggested that cytotoxic combination chemotherapy might be the another option for the treatment of progressive HCC. The patients with the age over 60 and a stable primary liver mass were benefit from the chemotherapy, leading to survival prolongation. Most clinical trials are currently focused on target agent because HCC is considered to be chemo-resistant cancer. Based on our data, new clinical trials using chemotherapy should be tried beyond sorafenib.