title: Treatment with all-trans retinoic acid plus tamoxifen and vitamin E in advanced hepatocellular carcinoma.
abstract: BACKGROUND
  Low serum retinol and hepatic tocopherol levels correlate with hepatocellular carcinoma (HCC) risk. Antiestrogen tamoxifen seems useful in HCC patients. A pilot study was performed to evaluate the effect of all-trans retinoic acid associated with tamoxifen and vitamin E on patients with advanced HCC.
  
  
  METHODS
  Fifteen consecutive patients with advanced HCC were included in the study. Patients were evaluated for survival, quality of life, liver function, tumor mass, toxicity related to the treatment and retinoid receptors in liver biopsies.
  
  
  RESULTS
  The median survival of our patients was 22 months. Pain and asthenia were improved in the majority of patients. Every patient with baseline elevated liver enzymes showed an improvement in liver function. RAR-alpha, RXR-alpha, RAR-beta and RAR-gamma receptors were demonstrated in 100%, 73%, 47% and 40%, respectively.
  
  
  CONCLUSIONS
  A combination therapy of all-trans retinoic acid, tamoxifen and vitamin E increases the survival rate and ameliorates the clinical outcome in patients with inoperable HCC.
authors.affiliation: Clinic of Gastroenterology and Hepatology, University of Perugia, Italy. clerici@unipg.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Clerici
authors.forename: Danilo
authors.initials: D
authors.lastname: Castellani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Russo
authors.forename: Stefano
authors.initials: S
authors.lastname: Fiorucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sabatino
authors.forename: Vittorio
authors.initials: V
authors.lastname: Giuliano
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gentili
authors.forename: Olivia
authors.initials: O
authors.lastname: Morelli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Raffo
authors.forename: Monia
authors.initials: M
authors.lastname: Baldoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Morelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Toma
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects; D014810:Vitamin E / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D013629:Tamoxifen; D014810:Vitamin E; D014212:Tretinoin