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Factors predicting response and survival in 149 patients with unresectable hepatocellular carcinoma treated by combination cisplatin, interferon‐alpha, doxorubicin and 5‐fluorouracil chemotherapy
Author(s) -
Leung Thomas W. T.,
Tang Amanda M. Y.,
Zee Benny,
Yu Simon C. H.,
Lai Paul B. S.,
Lau Wan Yee,
Johnson Philip J.
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10236
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , cirrhosis , fluorouracil , chemotherapy , doxorubicin , alpha interferon , cisplatin , interferon alfa , univariate analysis , surgery , multivariate analysis , interferon , cancer , immunology , immunotherapy
BACKGROUND The objective of the current study was to identify patient and disease related factors that influence response and survival for patients with unresectable hepatocellular carcinoma (HCC) who received a systemic combination chemotherapy consisting of cisplatin, alpha‐interferon, doxorubicin, and 5‐fluorouracil (PIAF). METHODS From July 1996 to February 1999, 149 patients with unresectable HCC were treated with PIAF: cisplatin (20mg/m 2 intravenously, Days 1–4), doxorubicin (40mg/m 2 intravenously, Day 1), 5‐fluorouracil (400mg/m 2 intravenously, Days 1–4), and alpha‐interferon (5MU/m 2 subcutaneously, Days 1–4), once every 3 weeks up to a maximum of six cycles. Univariate and multivariate analyses of patient and disease characteristics were used to identify factors predicting response and survival. RESULTS The objective response rate according to conventional criteria was 16.8% (complete response in 3 out of 149 patients, or 2%, 95% confidence interval [CI] 0–4.3%; partial response in 22 out of 149 patients, or 14.8%, 95% CI 9–20%). The median survival time was 30.9 weeks (95% CI 22.1 to 40). Significant independent predictors of an objective response were: absence of cirrhosis ( P = 0.006), low bilirubin level ( P = 0.006), and positive hepatitis C serology ( P = 0.025). The following factors were related to a shorter survival time: high Okuda stage ( P = 0.001), vascular involvement ( P = 0.018), and cirrhosis ( P = 0.008). Good risk patients (absence of cirrhosis and total bilirubin ≤ 0.6mg/dL) had an objective response rate of 50%. CONCLUSIONS Patients with unresectable HCC who also have normal total bilirubin and non‐cirrhotic livers have a better chance of response and prolonged survival after treatment with systemic PIAF. Cancer 2002;94:421–7. © 2002 American Cancer Society.