Activity and Tolerability of Courses of Intra-Arterial Chemotherapy Followed by Chemoembolization in Unresectable Hepatocellular Carcinoma

Abstract

Aims and Background

We previously reported encouraging response rates and survival with combined intraarterial (i.a.) chemotherapy and chemoembolization in unresectable hepatocellular carcinoma. We therefore evaluated a new program combining three courses of i.a. chemotherapy with chemoembolization administered every 28 days.

Patients and methods

The treatment regimen consisted of L-Ieucovorin (100 mg/m² i.v.), fluorouracil (800 mg/m² i.a.), and carboplatin (250 mg/m² i.a.). Chemoembolization with mitoxantrone (10 mg/m²) plus ethiodized oil and gelatin sponge was performed immediately after. The same treatment was given every 28 days for 3 times.

Results

Twenty-eight patients entered the study and were assessable for response and side effects. There were 24 males and 4 females (median age, 68 yrs; range, 42-75). TNM stage was II-III in 20 and IVA in 8; 17 were Child's A and 11 Child's B. Baseline α-fetoprotein was elevated in 15, and there was cirrhosis in 23. Twelve patients had a partial response (43%; 95% confidence interval, 24-63%), 13 had stabilization, and 3 progressive disease. Median survival was 16.6 months (range, 2-24). Sixteen patients had grade I-II pain and 14 grade I-II fever.

Conclusions

Our results indicate that the regimen is safe and well tolerated. Despite 43% objective remissions, our results do not seem better than those obtained with less intensive regimens.