title: Epirubicin, cisplatin, 5-FU combination chemotherapy in sorafenib-refractory metastatic hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the clinical efficacy and safety of epirubicin, cisplatin, and 5-FU combination chemotherapy for the sorafenib-refractory metastatic hepatocellular carcinoma (HCC).
  
  
  METHODS
  From April 2009 to June 2012, 31 patients who were diagnosed with metastatic and progressive HCC after sorafenib treatment were retrospectively reviewed. Patients were treated with the combination of epirubicin (50 mg/m(2) IV; day 1), cisplatin (60 mg/m(2) IV; day 1), and 5-FU (1000 mg/m(2) IV; day 1-3) [Epirubicin, cisplatin, 5-FU combination (ECF)], repeated every 4 wk.
  
  
  RESULTS
  The overall response rate was 12.9%. Patients who responded to ECF chemotherapy showed a longer overall survival (OS) and time to progression (TTP) relative to those in the non-responder group (OS: 20.4 mo vs 4.9 mo, P < 0.001, TTP: 9.4 mo vs 2.2 mo, P < 0.001). Patients with a stable primary liver mass also exhibited a longer OS and TTP relative to those with progressive disease (OS: 13.4 mo vs 5.3 mo, P = 0.003; TTP: 9.4 mo vs 2.3 mo, P = 0.003). The most common hematologic toxicity was thrombocytopenia (87.2%), and the incidence of grade 3-4 neutropenia was 53.9%. Age older than 60, a stable primary mass, and a good response to chemotherapy were prognostic factors for OS and TTP.
  
  
  CONCLUSIONS
  This combination cytotoxic chemotherapy can serve as another treatment option after sorafenib failure for the subset of patients with advanced metastatic HCC.
authors.affiliation: Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.affiliation: Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: You
authors.affiliation: Ji Eun Lee, Myung Ah Lee, Division of Medical Oncology, Hepato-Biliary-Pancreatic Cancer Center, Cancer Research Institute Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea.
authors.forename: Myung Ah
authors.initials: MA
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D015251:Epirubicin; D000077157:Sorafenib; D002945:Cisplatin; D005472:Fluorouracil
keywords: 5-FU; Cisplatin; Epirubicin; Hepatocellular carcinoma; Sorafenib