Complete pathological response of hepatocellular carcinoma with systemic combination chemotherapy.

Daris Ferrari, San Paolo Hospital, Department of  Oncology, Milan, Italy

The diagnosis of hepatocellular carcinoma (HCC) is increasing in frequency worldwide as it is correlated with chronic viral hepatitis C and cirrhosis. HCC has a propensity to recur locoregionally and patients should be treated with surgery or transcatheter hepatic arterial embolization (TAE) whenever possible. Systemic chemotherapy has not demonstrated to be much more effective than supportive care in advanced disease, nonetheless some good results can be obtained in young and fit patients with the association of epirubicin, cisplatin and 5-fluorouracil (ECF) [1].

Pathological complete responses are extraordinary rare [2,3]. We treated with the ECF regimen a patient affected by an intrahepatic recurrence of HCC and obtained the great result that no tumor viable cells were present in the surgery sample. This response was maintained for more than one year [4]. Recently new biological drugs have demonstrated to be effective in the treatment of advanced HCC [5]. Sorafenib is the first among these "target therapies" registered for this specific indication.

A patient like the one we described (see article), likely will benefit from sorafenib in case of recurrence. Apart from the justified hopes, we must look cautiously at the experience with sorafenib as its clinical use is still too brief and much time is needed to properly evaluate the effectiveness and the tolerability of the drug. Going by these results we can wish in the next future to offer our patients prolonged treatment with biological agents that are better tolerated than traditional chemotherapy. The combination of surgery, TAE and target therapy, perhaps associated with chemotherapy, reasonably will further prolong survival in HCC patients.

References

• Boucher E, Corbinais S, Brissot P, Boudjema K, Raoul J. Treatment of hepatocellular carcinoma (HCC) with systemic chemotherapy combining epirubicin, cisplatinum and infusional 5-fluorouracil (ECF regimen). Cancer Chemother Pharmacol. 2002;50(4):305-8.
• Leung TW, Patt YZ, Lau WY, Ho SK, Yu SC, Chan AT, Mok TS, Yeo W, Liew CT, Leung NW, Tang AM, Johnson PJ. Complete pathological remission is possible with systemic combination chemotherapy for inoperable hepatocellular carcinoma. Clin Cancer Res 1999;5:1676-81.
• Quek R, Lim ST, Ong S. Hepatocellular carcinoma. Pathological complete response to oral capecitabine, megestrol and thalidomide. Acta Oncol. 2006;45(1):95-7.
• Ferrari D, Di Maria G, Fazio N, Codecà C, Fiore J, Luciani A, Oldani S, Maggioni M, Foa P. Complete pathological response of hepatocellular carcinoma with systemic combination chemotherapy. Anticancer Drugs. 2008 Sep;19(8):837-40.
• Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Häussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J; SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008 Jul 24;359(4):378-90.

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