Feasibility of gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma patients with Child-Pugh B cirrhosis.
OBJECTIVE
Sorafenib improves survival in advanced hepatocellular carcinoma (HCC), but the demonstration of its efficacy and safety is limited to Child-Pugh A cirrhotic patients. The biweekly combination of gemcitabine and oxaliplatin (GEMOX) is safe and widely used in patients with advanced malignancies. We aimed to evaluate the feasibility of GEMOX in HCC patients with Child-Pugh B cirrhosis ineligible for sorafenib.


METHODS
The medical records of cirrhotic patients with advanced HCC receiving the GEMOX regimen between July 2006 and November 2011 were retrospectively reviewed. Treatment was repeated every 2 weeks until disease progression or unacceptable adverse effects occurred. The primary evaluation criterion was safety. Secondary evaluation criteria were the presence of muscle wasting (sarcopenia), response rate, progression-free survival and overall survival (OS).


RESULTS
Patients with Child-Pugh A (group A, n = 17) or Child-Pugh B cirrhosis (group B, n = 15) received a total of 169 cycles (median 4, range 1-16/patient). Eight patients in each group had sarcopenia. Common toxicities were thrombocytopenia (25 and 14 in groups A and B, respectively; p = 0.65) and peripheral neuropathy (44 and 54% in groups A and B, respectively; p = 1). Neither febrile neutropenia nor toxic death occurred. One patient in each group experienced grade 3 oesophageal varices bleeding. The response and disease control rates were 18% (95% CI 0-35.8) and 58.8% (95% CI 35.4-82.2) in group A, and 27% (95% CI 4.3-49.1) and 60.0% (95% CI 35.2-84.8) in group B. The median progression-free survival and OS did not differ between the two groups, but median OS was significantly shorter in sarcopenic patients.


CONCLUSIONS
The GEMOX regimen appears feasible in HCC patients with Child-Pugh B cirrhosis and exerts anti-tumour activity. These data need to be confirmed in a prospective study.
Department of Gastroenterology, Cochin Teaching Hospital, AP-HP, Paris, France.
Marion
M
Dhooge
Romain
R
Coriat
Olivier
O
Mir
Géraldine
G
Perkins
Catherine
C
Brezault
Pascaline
P
Boudou-Rouquette
François
F
Goldwasser
Stanislas
S
Chaussade
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000556:secondary; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D009944:Organoplatinum Compounds; D003841:Deoxycytidine