title: Somatostatin receptor expression, tumour response, and quality of life in patients with advanced hepatocellular carcinoma treated with long-acting octreotide.
abstract: Octreotide may extend survival in hepatocellular carcinoma (HCC). Forty-one per cent of HCCs have high-affinity somatostatin receptors. We aimed to determine the feasibility, safety, and activity of long-acting octreotide in advanced HCC; to identify the best method for assessing somatostatin receptor expression; to relate receptor expression to clinical outcomes; and to evaluate toxicity. Sixty-three patients with advanced HCC received intramuscular long-acting octreotide 20 mg monthly until progression or toxicity. Median age was 67 years (range 28-81 years), male 81%, Child-Pugh A 83%, and B 17%. The aetiologies of chronic liver disease were alcohol (22%), viral hepatitis (44%), and haemochromatosis (6%). Prior treatments for HCC included surgery (8%), chemotherapy (2%), local ablation (11%), and chemoembolisation (6%). One patient had an objective partial tumour response (2%, 95% CI 0-9%). Serum alpha-fetoprotein levels decreased more than 50% in four (6%). Median survival was 8 months. Thirty four of 61 patients (56%) had receptor expression detected by scintigraphy; no clear relationship with clinical outcomes was identified. There were few grade 3 or 4 toxicities: hyperglycaemia (8%), hypoglycaemia (2%), diarrhoea (5%), and anorexia (2%). Patients reported improvements in some symptoms, but no major changes in quality of life were detected. Long-acting octreotide is safe in advanced HCC. We found little evidence of anticancer activity. A definitive randomised trial would identify whether patients benefit from this treatment in other ways.
authors.affiliation: AGITG Trial Coordinating Centre, NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia. jonathan.cebon@ludwig.edu.au
authors.forename: J
authors.initials: J
authors.lastname: Cebon
authors.forename: M
authors.initials: M
authors.lastname: Findlay
authors.forename: C
authors.initials: C
authors.lastname: Hargreaves
authors.forename: M
authors.initials: M
authors.lastname: Stockler
authors.forename: P
authors.initials: P
authors.lastname: Thompson
authors.forename: M
authors.initials: M
authors.lastname: Boyer
authors.forename: S
authors.initials: S
authors.lastname: Roberts
authors.forename: A
authors.initials: A
authors.lastname: Poon
authors.forename: A M
authors.initials: AM
authors.lastname: Scott
authors.forename: V
authors.initials: V
authors.lastname: Kalff
authors.forename: G
authors.initials: G
authors.lastname: Garas
authors.forename: A
authors.initials: A
authors.lastname: Dowling
authors.forename: D
authors.initials: D
authors.lastname: Crawford
authors.forename: J
authors.initials: J
authors.lastname: Ring
authors.forename: R
authors.initials: R
authors.lastname: Basser
authors.forename: A
authors.initials: A
authors.lastname: Strickland
authors.forename: G
authors.initials: G
authors.lastname: Macdonald
authors.forename: M
authors.initials: M
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Nowak
authors.forename: B
authors.initials: B
authors.lastname: Dickman
authors.forename: H
authors.initials: H
authors.lastname: Dhillon
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authors.initials: V
authors.lastname: Gebski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D053379:Chromogranin A; D002864:Chromogranins / Q000187:drug effects; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011788:Quality of Life; D017481:Receptors, Somatostatin / Q000096:biosynthesis* / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D053379:Chromogranin A; D002864:Chromogranins; D003692:Delayed-Action Preparations; D017481:Receptors, Somatostatin; D015282:Octreotide