title: A pilot study of hepatic arterial infusion of chemotherapy for patients with advanced hepatocellular carcinoma who have failed anti-angiogenic therapy.
abstract: OBJECTIVE
  For patients with advanced hepatocellular carcinoma (HCC) who have failed first-line anti-angiogenic therapy, there is no salvage treatment. Hepatic arterial infusion of chemotherapy (HAIC) has been reported to achieve substantial treatment responses in HCC patients. We aimed to explore the feasibility of using HAIC as second-line therapy for advanced HCC.
  
  
  METHODS
  We retrospectively reviewed all consecutive patients who received HAIC for advanced HCC after failure of first-line anti-angiogenic therapy at a single institute. Patients received HAIC with 60 mg/m(2) cisplatin on Day 2, and 500 mg/m(2) /d dose of 5-fluorouracil on Days 1-3. The treatment was repeated every 21 days and continued until disease progression or the occurrence of intolerable toxicities. Tumour assessment was performed after every 3 cycles of HAIC following RECIST criteria, version 1.0.
  
  
  RESULTS
  A total of 23 patients were included. Eleven (48%) patients had main portal vein thrombosis. Liver reserve was classified as Child-Pugh A in 19 (83%) patients and B in 4 (17%) patients. No complete response was observed, although 6 (26%) patients showed partial responses. The median progression-free survival was 4.4 months, and the median overall survival was 7.5 months. Common toxicities included bone marrow suppression, elevated transaminase levels, neutropenia, nausea and malaise. Only 7 (30%) patients experienced grade 3 or 4 toxicities, and no patients withdrew from the therapy because of intolerable or life-threatening toxicities.
  
  
  CONCLUSIONS
  HAIC is a feasible second-line therapy for patients with advanced HCC who have failed anti-angiogenic therapy.
authors.affiliation: Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Yu-Yun
authors.initials: YY
authors.lastname: Shao
authors.forename: Po-Chin
authors.initials: PC
authors.lastname: Liang
authors.forename: Yao-Ming
authors.initials: YM
authors.lastname: Wu
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Huang
authors.forename: Kai-Wen
authors.initials: KW
authors.lastname: Huang
authors.forename: Jason C
authors.initials: JC
authors.lastname: Cheng
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Hsu
authors.forename: Chiun
authors.initials: C
authors.lastname: Hsu
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Zhong-Zhe
authors.initials: ZZ
authors.lastname: Lin
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D002945:Cisplatin / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods*; D008113:Liver Neoplasms / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D010865:Pilot Projects; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins; D002945:Cisplatin
keywords: Anti-angiogenic therapy; hepatic arterial infusion of chemotherapy; hepatocellular carcinoma; salvage therapy