Role of metronomic capecitabine in advanced hepatocellular carcinoma.

Abstract

e15119 Background: Hepatocellular carcinoma is one of the top five cancers in countries where viral hepatitis is an endemic disease like Pakistan. Its incidence is rising continuously. Limited options are available for advanced stage disease in old and frail patients. These are intolerant to chemotherapy and biological therapy. Moreover, cost of biological therapy render their use limited in limited resource country. There is a desperate need for a treatment that is effective as well as minimal toxic to these patients so that quality of life is improved in this population. Methods: This study is aimed at testing the efficacy of low dose capecitabine (1000 mg daily in two divided doses) in newly diagnosed advanced hepatocellular carcinoma. Patients were planned to receive this treatment for three months followed by response assessment using ultrasound findings and alpha fetoprotein (AFP) levels compared to baseline findings. Various quality of life parameters including pain score, appetite, weight gain and performance status were also assessed. Results: Total of seventy patients were enrolled. Fifty five patients completed the treatment for three months and were available for evaluation. Two patients (3.6%) had complete response, twelve (21.8%) had partial response, nineteen (34.5%) had stable disease and twenty two (40%) had progressive disease. Thirty nine patients (70.9%) showed significant reduction in AFP levels. Pain score improved in forty two (76.4%) patients, appetite was increased in thirty seven patients (67.2%), weight was gained in twelve patients (21.8%) and performance status was improved in seventeen patients (30.9%). Six patients had one or more episode of grade 2 diarrhea, four patients developed encephalopathy and only one patients developed hand foot syndrome. Conclusions: Low dose continuous capecitabine is effective in advanced hepatocellular carcinoma with excellent tolerability and minimal toxicity.