title: alpha-fetoprotein response predicts survival benefits of thalidomide in advanced hepatocellular carcinoma.
abstract: BACKGROUND
  Radiographic measurements do not always reflect the biological response of hepatocellular carcinoma to drug therapy.
  
  
  OBJECTIVE
  To evaluate the clinical implications of tumour marker (alpha-fetoprotein) response in advanced hepatocellular carcinoma patients with thalidomide treatment.
  
  
  METHODS
  Forty-two advanced hepatocellular carcinoma patients with baseline alpha-fetoprotein levels above 200 ng/mL and thalidomide therapy were included. Serum alpha-fetoprotein levels were measured every 4 weeks. alpha-fetoprotein response was defined as a 50% or greater reduction of alpha-fetoprotein levels for 4 or more weeks during treatment. Radiographic response was assessed by World Health Organization criteria; survivals were estimated by Kaplan-Meier method and prognostic factors were assessed by Cox's proportional hazard model.
  
  
  RESULTS
  With intention-to-treat analysis, radiographic response and alpha-fetoprotein response were obtained in 7% (three of 42, 95% confidence interval: 0-15) and 24% (10 of 42, 95% CI: 10-38) of patients, respectively. All radiographic response was observed in alpha-fetoprotein responders. Multivariate analyses showed alpha-fetoprotein response was independent prognostic factor for both progression-free survival (relative risk = 0.394, 95% CI: 0.189-0.820, P = 0.013) and overall survival (relative risk = 0.241, 95% CI: 0.096-0.606, P =0.003), whereas radiographic response was not.
  
  
  CONCLUSIONS
  alpha-fetoprotein response can more accurately reflect the biological response of advanced hepatocellular carcinoma to thalidomide therapy than radiographic response.
authors.affiliation: Division of Cancer Research, National Health Research Institutes, Veterans General Hospital, Taipei, Taiwan. leochen@nhri.org.tw
authors.forename: L-T
authors.initials: LT
authors.lastname: Chen
authors.forename: T-W
authors.initials: TW
authors.lastname: Liu
authors.forename: Y
authors.initials: Y
authors.lastname: Chao
authors.forename: H-S
authors.initials: HS
authors.lastname: Shiah
authors.forename: J-Y
authors.initials: JY
authors.lastname: Chang
authors.forename: S-H
authors.initials: SH
authors.lastname: Juang
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: T-R
authors.initials: TR
authors.lastname: Chuang
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chin
authors.forename: J
authors.initials: J
authors.lastname: Whang-Peng
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D013792:Thalidomide / Q000627:therapeutic use*; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D020533:Angiogenesis Inhibitors; D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins; D013792:Thalidomide