Systemic combination therapy of intravenous continuous 5-fluorouracil and subcutaneous pegylated interferon alfa-2a for advanced hepatocellular carcinoma

• Published in: Journal of gastroenterology Vol. 47; no. 10; pp. 1152 - 1159
• Main Authors: Uchino, Koji, Obi, Shuntaro, Tateishi, Ryosuke, Sato, Shinpei, Kanda, Miho, Sato, Takahisa, Arano, Toru, Enooku, Kenichiro, Goto, Eriko, Masuzaki, Ryota, Nakagawa, Hayato, Asaoka, Yoshinari, Kondo, Yuji, Yamashiki, Noriyo, Goto, Tadashi, Shiina, Shuichiro, Omata, Masao, Yoshida, Haruhiko, Koike, Kazuhiko
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.10.2012; Springer; Springer Nature B.V
• Subjects: 5-Fluorouracil; Abdominal Surgery; Ablation (Surgery); Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - adverse effects; Antimetabolites, Antineoplastic - therapeutic use; Antimitotic agents; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Biliary Tract; Biological response modifiers; Cancer; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - mortality; Care and treatment; Chemotherapy; Cohort Studies; Colorectal Surgery; Combination therapy; Female; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Fluorouracil - therapeutic use; Gastroenterology; Hepatic artery; Hepatocellular carcinoma; Hepatology; Hepatoma; Humans; Infusions, Intravenous; Injections, Subcutaneous; Interferon; Interferon alpha; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Intravenous administration; Japan; Leukopenia; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Male; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Multivariate analysis; Original Article—Liver; Pancreas; Patients; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Retrospective Studies; Stenosis; Surgical Oncology; Survival; Survival Rate; Thrombocytopenia; Treatment Outcome; Viral antigens; α-Interferon; Japan; Time to progression; Survival analysis; Hepatocellular carcinoma; Systemic chemotherapy
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-012-0574-3

Background In Japan, sorafenib is now the first-line therapy for individuals with advanced hepatocellular carcinoma (HCC), but no other treatment is available for such patients. The aim of this study was to assess the efficacy and safety of combination therapy with systemic continuous intravenous infusion of 5-fluorouracil (5-FU) and subcutaneous peginterferon alfa-2a, which was used before sorafenib was introduced to Japan. Methods Two hundred and twenty-three HCC patients, who were not amenable to curative surgery, percutaneous ablation, or transarterial chemoembolization (TACE), and for whom intraarterial chemotherapy was not indicated because of the presence of extrahepatic metastasis or stenosis of the common hepatic artery, received peginterferon alfa-2a (90 μg subcutaneously on days 1, 8, 15, and 22) and 5-FU (500 mg/day intravenously given continuously on days 1–5 and 8–12). We assessed their response to treatment and survival, and treatment safety. Results The response rate was 9.4 % (including six patients with complete response) and the disease-control rate was 32.7 %. The median time to progression was 2.0 months. The overall median survival time was 6.5 months (Child–Pugh class A: 9.2 months vs. Child–Pugh class B: 2.8 months). In a multivariate analysis, Eastern Cooperative Oncology Group (ECOG) performance status >0, Child–Pugh class B, and the presence of macroscopic vascular invasion were independent predictors of poor prognosis. The major grade 3–4 adverse events were leucopenia (13.9 %) and thrombocytopenia (5.8 %). No treatment-related deaths occurred. Conclusions This combination therapy was well tolerated and showed promising efficacy. Further studies are needed to establish the usefulness of this treatment.