Abstract
Despite the availability of molecularly targeted agents for advanced hepatocellular carcinoma (aHCC), these are limited to compensated cirrhotic patients, and concerns about decreased hepatic functional reserve (HFR) and unknown adverse events, which may affect long-term survival, remain unaddressed. In this study, we enrolled 96 aHCC patients treated with bimonthly hepatic arterial infusion chemotherapy (B-HAIC) with cisplatin or sorafenib monotherapy (oral sorafenib 400 mg twice daily) not only to demonstrate its efficacy and significance but also to indicate preferable candidates by setting a response-related biomarker. Differences in treatment had no significant effect on overall survival (OS). The response rate in patients treated with B-HAIC was relatively higher than those treated with sorafenib. HFR was well maintained over the treatment course with B-HAIC, while it was significantly impaired with sorafenib. By employing multivariate analysis, we found negative trends between progression-free survival (PFS) periods and serum levels of alpha fetoprotein as well as des-gamma-carboxy prothrombin (DCP). In addition, a logistic regression analysis of the relationship between serum DCP levels and PFS periods over 420 days (14 months) showed that the PFS periods of patients with higher DCP was significantly shorter than those of patients with lower DCP (p = 0.02). Subsequently, the present study demonstrated the efficacy and safety of B-HAIC and identified a predictor of unpreferable patients. Based on these results, B-HAIC might be an alternative treatment after the implementation of new molecularly targeted therapies.
Highlights
Improvements in various diagnostic imaging techniques and significant advances in endoscopic techniques over the last few decades have led to improved treatment outcomes for cancers of the gastrointestinal tract, especially gastric and colorectal cancers, in terms of physical treatment burden and long-term prognosis
We previously showed that bimonthly hepatic arterial infusion chemotherapy (BHAIC) with one-shot cisplatin infusion at eight-week intervals could be an alternative treatment for transcatheter arterial chemoembolization (TACE)-refractory Advanced hepatocellular carcinoma (aHCC) in both compensated and decompensated cirrhotic patients with aHCC treated in our hospital [10,11]
Among 417 hepatocellular carcinoma (HCC) patients seen at our hospital between January 2009 and June 2015, 103 patients with aHCC and refractory to TACE, adequately assessed by radiological imaging, and with sufficient blood test results were included in the study
Summary
Improvements in various diagnostic imaging techniques and significant advances in endoscopic techniques over the last few decades have led to improved treatment outcomes for cancers of the gastrointestinal tract, especially gastric and colorectal cancers, in terms of physical treatment burden and long-term prognosis. Lenvatinib demonstrated a more favorable outcome than transcatheter arterial chemoembolization (TACE) in patients with large or multinodular intermediate-stage HCC who did not benefit from TACE [6] and showed potential benefits for aHCC patients using second-line or later therapies and a high burden of intrahepatic lesions [7] Based on these findings, the latest version of the HCC treatment practice guidelines recommends lenvatinib in addition to sorafenib for aHCC [2,3]. The combined used of atezolizumab, an immune checkpoint inhibitor (programmed cell death receptor ligand 1 antibody), and bevacizumab, a vascular endothelial growth factor receptor antibody product, showed greater overall survival (OS) compared with sorafenib monotherapy treatment [8] These findings may represent a change in future treatment for aHCC. Low albumin levels have been reported to predict the long-term prognosis of patients with liver disease, including those with cirrhosis, as a decline in HFR often begins with decreased serum albumin levels [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
