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Efficacy and safety of epirubicin and etoposide combination chemotherapy in advanced hepatocellular carcinoma: A retrospective analysis
Author(s) -
Lee JaeLyun,
Ryu MinHee,
Chang Heung M,
Kim TaeWon,
Lee Sung S,
Sym Sun J,
Kim Min K,
Kim Kang M,
Lee Jung S,
Kang YoonKoo
Publication year - 2008
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2007.05213.x
Subject(s) - medicine , epirubicin , hepatocellular carcinoma , etoposide , hbsag , chemotherapy , gastroenterology , carboplatin , hepatitis b , surgery , oncology , cisplatin , hepatitis b virus , cyclophosphamide , immunology , virus
Background and Aim: Systemic treatments of advanced hepatocellular carcinoma (AHCC) have offered marginal clinical benefits. Recently, Italian investigators reported that etoposide and epirubicin combination (EE) chemotherapy was highly active against AHCC, with a response rate of 39% and a median overall survival (OS) of 10 months. We report our efficacy and safety results of EE in clinical practice. Methods: Between December 1999 and October 2005, 35 patients with AHCC and fitting the preset eligibility criteria were treated with EE. Twenty‐eight patients (80%) had liver disease associated with hepatitis B virus (HBV) and 26 (74%) had a prior history of transarterial chemoembolization (TACE) using cisplatin. The EE chemotherapy consisted of epirubicin 40 mg/m 2 on day 1 and etoposide 120 mg/m 2 on days 1, 3 and 5 every 4 weeks. Results: A total of 102 chemotherapy cycles were administered, with a median of two cycles per patient (range one to eight cycles). Two patients had a partial response and nine had stable disease, with a tumor control rate of 32% (95% CI 17–48). The median progression‐free survival (PFS) was 2.1 months (95% CI 1.8–2.4) and the median OS was 6.4 months (95% CI 4.4–8.5). There was a tendency toward improved PFS in patients seronegative for HBsAg and peritoneal seeding ( P = 0.06 and P = 0.054, respectively). Overall survival was significantly better in patients without HBsAg and Cancer Liver Italian Program (CLIP) score 0–1 ( P = 0.024 and P = 0.033, respectively). The main toxicities were hematological events, including grade 3/4 neutropenia in 29% and febrile neutropenia in 11% of patients. Conclusion: Treatment with EE showed minimal antitumor activity with acceptable toxicity in HBV‐associated AHCC, especially in patients pretreated with TACE.