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Abstract
BackgroundThere is no global consensus for the optimal management of HCC. Most of patients at the time of diagnosis are not candidate for potentially curative therapy. The study aimed to evaluate the efficacy of low dose capecitabine combined with sorafenib in subset of Egyptian HCV patients presented with advanced HCC unfit for surgical or locoregional therapies.Methods15 patients with advanced HCC, unfit for surgical or locoregional intervention, with PS <2 recieved Capecitabine 500 mg/day with sorafeneb 200 mg twice daily till normalization of AFP then the treatment was modified to capecitabine 250 mg every other day and sorafenib 400 mg once daily. They were followed every 3 months for size, number of focal masses and AFP. 30 patients were selected as a control group, they received supportive therapy (n = 15) or sorafenib only (n = 15).ResultsAfter 10 months of therapy, 6 patients showed complete response (40 %) with complete recanalization of portal vein (n = 2) and treatment was stopped and the others (n = 4) showed partial portal vein recanalization so, treatment is continued till now. 1 patient (6.7 %) showed recurrence of the disease and died after 1 month, 8 patients showed partial response (53.3 %) and still on treatment. The control groups showed a highly significant reduction in survival when compared to patients who received capecitabine and sorafenib (12.9 ± 2.1, 7.9 ± 0.9, 4.5 ± 1.3 months, p = 0.000).ConclusionsCombined low dose capecitabine and sorafenib proved to be safe with low toxicity profile and deserves further attention as a convenient, outpatient-based chemotherapy in patients with advanced HCC.
Highlights
There is no global consensus for the optimal management of hepatocellular carcinoma (HCC)
The increasing number of patients presented with advanced HCC with no other eligible treatment options that can be offered for them as surgery, local ablative therapies or chemoembolization will put us in a challenging situation, so the aim of this work is to evaluate the efficacy of low dose capecitabine combined with sorafenib which are potentially safe and effective drugs based on previous studies, in subset of Egyptian hepatitis C virus (HCV) patients presented with advanced HCC who were unfit for surgical or loco regional therapies
Subjects and methods In the period extending from April 2014 till February 2016, at Hepatology outpatient clinic—Zagazig University hospital, the efficacy of capecitabine combination with sorafenib was evaluated in the management of advanced inoperable HCC unfit for surgical or locoregional therapies, and the patients had an adequate hepatic reserve with performance status (PS) ≤2
Summary
There is no global consensus for the optimal management of HCC. Most of patients at the time of diagnosis are not candidate for potentially curative therapy. The study aimed to evaluate the efficacy of low dose capecitabine combined with sorafenib in subset of Egyptian HCV patients presented with advanced HCC unfit for surgical or locoregional therapies. Hanafy SpringerPlus (2016)5:1675 elevated AFP above normal value without abnormal radiological findings may predict the future development of HCC (Forner et al 2009). There are no established guidelines for the adequate management of HCC, according to Barcelona Clinic Liver Cancer (BCLC) staging system which is a widely endorsed system; patients with early HCC defined as a single nodule or three nodules
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