Chapter 088. Hepatocellular Carcinoma (Part 8) docx

Hepatocellular Carcinoma Part 8 Table 88-5 Some Randomized Clinical Trials Involving Transhepatic Artery Chemoembolization TACE for Hepatocellular Carcinoma r Agents 1 Agents 2 Survi

Chapter 088 Hepatocellular

Carcinoma

(Part 8)

Table 88-5 Some Randomized Clinical Trials Involving Transhepatic Artery Chemoembolization (TACE) for Hepatocellular Carcinoma

r

Agents 1 Agents 2 Surviva

l Effect

Kawaii 1992 Doxorubici

n + embo

Embo No

Chang 1994 Cisplatin +

embo

Embo No

Hatanaka 1995 Cisplatin,

doxorubicin + embo

Same + ethiodol

No

Uchino 1993 Cisplatin,

doxorubicin + oral

FU

Same + tamoxifen

No

Lin 1988 Embo Embo +

IV FU

No

Yoshikaw

a

1994 Epirubicin + ethiodol (Lipiodol)

Epirubici

n

No

Pelletier 1990 Doxorubici

n + Gelfoam

None No

Trinchet 1995 Cisplatin +

Gelfoam

None No

Bruix 1998 Coils and

Gelfoam

None No

Pelletier 1998 Cisplatin +

ethiodol

None No

Trinchet 1995 Cisplatin +

Gelfoam

None No

Pelletier 1998 Cisplatin +

ethiodol

None No

Lo 2002 Cisplatin +

ethiodol

None Yes

Llovet 2002 Doxorubici

n + ethiodol

None Yes

Note: embo, embolization; FU, fluorouracil

Experimental Therapies

Several therapies are being evaluated (Table 88-6) Epidermal growth factor (EGF) receptor antibodies and EGF receptor kinase inhibitors are in clinical trials, as are various anti-angiogenesis therapies No effects on survival are yet reported Oral sorafenib increases median survival from 6 to 9 months in

advanced, unresectable HCC Several forms of radiation therapy have been used

in the treatment of HCC, including external beam and conformal radiation therapy Radiation hepatitis remains a significant dose-limiting problem The pure beta emitter 90yttrium attached to either glass or resin microspheres has been assessed

in phase II trials of HCC and has encouraging survival effects with minimal toxicities Randomized trials have yet to be performed Vitamin K has been assessed in clinical trials at high dosage for its HCC-inhibitory actions This idea

is based on the characteristic biochemical defect in HCC of elevated plasma levels

of immature prothrombin (DCP or PIVKA-2), due to a defect in the activity of prothrombin carboxylase, a vitamin K–dependent enzyme Two vitamin K randomized controlled trials from Japan show decreased tumor occurrence Patient participation in clinical trials aimed at assessing new therapies is encouraged