title: Metronomic capecitabine in patients with hepatocellular carcinoma unresponsive to or ineligible for sorafenib treatment: report of two cases.
abstract: BACKGROUND
  Sorafenib, an oral multikinase inhibitor, is the only systemic agent proven to be effective in patients with hepatocellular carcinoma (HCC). There are no approved second line systemic therapies in patients who have had disease progression on or are not eligible to sorafenib.
  
  
  METHODS
  We describe two cases of unresectable HCC that were treated with low, "metronomic" doses of capecitabine. In the first patient, capecitabine was used after sorafenib failure. In the second case, treatment with capecitabine was attempted since the patient was considered not eligible for sorafenib due to spontaneous hepatic bleeding of a large HCC lesion. Treatment was effective and well tolerated in both patients with long-lasting objective responses.
  
  
  CONCLUSIONS
  Lacking established second-line therapy, metronomic capecitabine may be a valid alternative in the treatment of HCC patients who are judged not eligible for sorafenib or those having progression disease on sorafenib.
authors.affiliation: Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Marinelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Granito
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Matteo
authors.initials: M
authors.lastname: Renzulli
authors.forename: Angela
authors.initials: A
authors.lastname: Stagni
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
keywords: Capecitabine; Hepatocellular Carcinoma; Sorafenib