title: Efficacy and safety of epirubicin and etoposide combination chemotherapy in advanced hepatocellular carcinoma: a retrospective analysis.
abstract: OBJECTIVE
  Systemic treatments of advanced hepatocellular carcinoma (AHCC) have offered marginal clinical benefits. Recently, Italian investigators reported that etoposide and epirubicin combination (EE) chemotherapy was highly active against AHCC, with a response rate of 39% and a median overall survival (OS) of 10 months. We report our efficacy and safety results of EE in clinical practice.
  
  
  METHODS
  Between December 1999 and October 2005, 35 patients with AHCC and fitting the preset eligibility criteria were treated with EE. Twenty-eight patients (80%) had liver disease associated with hepatitis B virus (HBV) and 26 (74%) had a prior history of transarterial chemoembolization (TACE) using cisplatin. The EE chemotherapy consisted of epirubicin 40 mg/m(2) on day 1 and etoposide 120 mg/m(2) on days 1, 3 and 5 every 4 weeks.
  
  
  RESULTS
  A total of 102 chemotherapy cycles were administered, with a median of two cycles per patient (range one to eight cycles). Two patients had a partial response and nine had stable disease, with a tumor control rate of 32% (95% CI 17-48). The median progression-free survival (PFS) was 2.1 months (95% CI 1.8-2.4) and the median OS was 6.4 months (95% CI 4.4-8.5). There was a tendency toward improved PFS in patients seronegative for HBsAg and peritoneal seeding (P = 0.06 and P = 0.054, respectively). Overall survival was significantly better in patients without HBsAg and Cancer Liver Italian Program (CLIP) score 0-1 (P = 0.024 and P = 0.033, respectively). The main toxicities were hematological events, including grade 3/4 neutropenia in 29% and febrile neutropenia in 11% of patients.
  
  
  CONCLUSIONS
  Treatment with EE showed minimal antitumor activity with acceptable toxicity in HBV-associated AHCC, especially in patients pretreated with TACE.
authors.affiliation: Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Ryu
authors.forename: Heung M
authors.initials: HM
authors.lastname: Chang
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Sung S
authors.initials: SS
authors.lastname: Lee
authors.forename: Sun J
authors.initials: SJ
authors.lastname: Sym
authors.forename: Min K
authors.initials: MK
authors.lastname: Kim
authors.forename: Kang M
authors.initials: KM
authors.lastname: Kim
authors.forename: Jung S
authors.initials: JS
authors.lastname: Lee
authors.forename: Yoon-Koo
authors.initials: YK
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000473:pathology; D015251:Epirubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies
chemical_list: D015251:Epirubicin; D005047:Etoposide