Chemoembolization May Be Treatment of Choice in Liver Cancer Subgroup

November 06, 2002

Neil Osterweil

Nov. 6, 2002 (Boston) — When surgery is not an option for treatment of hepatocellular carcinoma, arterial chemoembolization, but not tamoxifen, may prolong survival of patients with advanced disease, reported Spanish researchers here at the 53rd Annual Meeting of the American Association for the Study of Liver Diseases.

In a meta-analysis of randomized controlled trials, Josep Llovet, MD, and colleagues from the University of Barcelona, Spain, found that "chemoembolization improves survival in a subset of patients with unresectable hepatocellular carcinoma, and may be considered the standard treatment for them. Tamoxifen does not modify survival of patients with advanced disease."

The patients who could benefit most from chemoembolization with either cisplatin or doxorubicin are "the patients who belong to Child-Pugh class A with multinodal or asymptomatic tumors, that achieve partial responses after two treatments. This is the best target population,” said Dr. Llovet, senior researcher in the Hospital Clinic at the University of Barcelona.

“This has been a question that has bugged the hepatology community for some time now, as to whether chemoembolization really was effective or not, and this year, for the first time, there have been two positive trials, and the two trials on their own are hopeful and suggestive of [efficiacy], but you need the strength of a meta-analysis to confirm it ,” Morris Sherman, MD, associate professor of medicine at University of Toronto, who was not involved in the study, told Medscape. “I think this was an excellently performed meta-analysis — they hit all the major points — and I think the conclusion is correct."

The authors conducted a systematic review of randomized controlled clinical trials for unresectable hepatocellular carcinoma. They found 25 studies that included a control group of patients who were managed either conservatively or with suboptimal therapies, and determined that they could perform a meta-analysis on seven studies each of arterial embolization/chemoembolization and tamoxifen

The primary endpoint of the analysis was survival, with treatment response a secondary endpoint. The analysis found that embolization/chemoembolization improved two-year survival, but a sensitivity analysis of the type of embolization showed a benefit for chemoembolization only.

The authors found that chemoembolization produced objective responses in 35% of patients (range, 16%-61%). “Tamoxifen showed no survival benefits...and only low quality scale trials suggested survival benefits,” the authors write.

"Chemoebolization is the treatment of choice in this disease and should be widely implemented,” Dr. Sherman told Medscape.

AASLD 53rd Annual Meeting: Abstract 896. Presented Nov. 5, 2002.

Reviewed by Gary D. Vogin, MD

Neil Osterweil is a freelance writer for Medscape.

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