Treatment with all-trans retinoic acid plus tamoxifen and vitamin E in advanced hepatocellular carcinoma.
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.
Clerici
Carlo
C
Clinic of Gastroenterology and Hepatology, University of Perugia, Italy. clerici@unipg.it
Castellani
Danilo
D
Russo
Giuseppe
G
Fiorucci
Stefano
S
Sabatino
Giuseppe
G
Giuliano
Vittorio
V
Gentili
Giorgio
G
Morelli
Olivia
O
Raffo
Patrizia
P
Baldoni
Monia
M
Morelli
Antonio
A
Toma
Salvatore
S
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
D013629:Tamoxifen; D014810:Vitamin E; D014212:Tretinoin