Chapter 088. Hepatocellular Carcinoma (Part 8)

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Table 88-5 Some Randomized Clinical Trials Involving Transhepatic Artery Chemoembolization (TACE) for Hepatocellular Carcinoma Yea Agents 1 Agents 2 Surviva l Effect Kawaii 1992 Doxorubici n + embo Embo No Chang 1994 embo Cisplatin + Embo No Hatanaka 1995 Cisplatin, doxorubicin embo Same + ethiodol + No Uchino 1993 Cisplatin, Same + No doxorubicin + oral tamoxifen FU Lin 1988 Embo IV FU Embo + No Yoshikaw a 1994 + Epirubicin ethiodol n Epirubici No (Lipiodol) Pelletier 1990 Doxorubici n + Gelfoam None No Trinchet 1995 Cisplatin + Gelfoam None No Bruix 1998 Coils Gelfoam and None No Pelletier 1998 Cisplatin + ethiodol None No Trinchet 1995 Cisplatin + Gelfoam None No Pelletier 1998 Cisplatin + ethiodol None No Lo 2002 Cisplatin + ethiodol None Yes Llovet 2002 Doxorubici n + ethiodol None Yes Note: embo, embolization; FU, fluorouracil. Experimental...

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Chapter 088. Hepatocellular Carcinoma (Part 8) Table 88-5 Some Randomized Clinical Trials Involving Transhepatic Artery Chemoembolization (TACE) for Hepatocellular Carcinoma Author Yea Agents 1 Agents 2 Surviva r l Effect Kawaii 1992 Doxorubici Embo No n + embo Chang 1994 Cisplatin + Embo No embo
Hatanaka 1995 Cisplatin, Same + No doxorubicin + ethiodol embo Uchino 1993 Cisplatin, Same + No doxorubicin + oral tamoxifen FU Lin 1988 Embo Embo + No IV FU Yoshikaw 1994 Epirubicin Epirubici No a + ethiodol n (Lipiodol) Pelletier 1990 Doxorubici None No n + Gelfoam Trinchet 1995 Cisplatin + None No Gelfoam
Bruix 1998 Coils and None No Gelfoam Pelletier 1998 Cisplatin + None No ethiodol Trinchet 1995 Cisplatin + None No Gelfoam Pelletier 1998 Cisplatin + None No ethiodol Lo 2002 Cisplatin + None Yes ethiodol Llovet 2002 Doxorubici None Yes n + ethiodol Note: embo, embolization; FU, fluorouracil. Experimental Therapies
Several therapies are being evaluated (Table 88-6). Epidermal growth factor (EGF) receptor antibodies and EGF receptor kinase inhibitors are in clinical trials, as are various anti-angiogenesis therapies. No effects on survival are yet reported. Oral sorafenib increases median survival from 6 to 9 months in advanced, unresectable HCC. Several forms of radiation therapy have been used in the treatment of HCC, including external beam and conformal radiation therapy. Radiation hepatitis remains a significant dose-limiting problem. The pure beta 90 emitter yttrium attached to either glass or resin microspheres has been assessed in phase II trials of HCC and has encouraging survival effects with minimal toxicities. Randomized trials have yet to be performed. Vitamin K has been assessed in clinical trials at high dosage for its HCC-inhibitory actions. This idea is based on the characteristic biochemical defect in HCC of elevated plasma levels of immature prothrombin (DCP or PIVKA-2), due to a defect in the activity of prothrombin carboxylase, a vitamin K–dependent enzyme. Two vitamin K randomized controlled trials from Japan show decreased tumor occurrence. Patient participation in clinical trials aimed at assessing new therapies is encouraged.