Treatment of HCC with pravastatin, octreotide, or gemcitabine--a critical evaluation.
OBJECTIVE
New perspectives in the treatment of advanced hepatocellular carcinomas have recently been inaugurated with the application of hydroxymethylglutaryl coenzyme A reductase inhibitors i.e. pravastatin, the somatostatin analogue octreotide, or the cytidine analogue gemcitabine. The present study aimed to evaluate these substances in patients with progressive tumor growth.


METHODS
A total of 58 patients either received 3 x 200 microg/day octreotide for 2 months followed by 20mg octreotide LAR every 4 weeks (n=30) or 40-80 mg pravastatin (n=20) or 80-90 mg/m2 gemcitabine over 24 hours weekly in cycles of 4 weeks (n=8). Kaplan-Meier survival curves and the log-rank test were used for univariate comparison of sur vival.


RESULTS
The median overall survival of patients receiving octreotide was 5 months, of patients receiving pravastatin 7.2 months and of patients receiving gemcitabine 3.5 months. The difference between the pravastatin and the gemcitabine groups was significant. No WHO grade 3 or 4 side effects were seen in either group of patients.


CONCLUSIONS
These results do not confirm those of former studies. Neither pravastatin, nor octreotide, nor gemcitabine did prolong the patients' median overall survival as compared to control groups reported by other authors. New therapeutic strategies have to be found for patients with advanced hepatocellular carcinomas.
Lersch
C
C
II. Department of Internal Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany. christian.lersch@lrz.tum.de
Schmelz
R
R
Erdmann
J
J
Hollweck
R
R
Schulte-Frohlinde
E
E
Eckel
F
F
Nader
M
M
Schusdziarra
V
V
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D017035:Pravastatin / Q000627:therapeutic use*; D016019:Survival Analysis; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D018931:Antineoplastic Agents, Hormonal; D003841:Deoxycytidine; D017035:Pravastatin; D015282:Octreotide; D000093542:Gemcitabine