Goda Yoshihiro, Morimoto Manabu, Irie Kuniyasu, Kobayashi Satoshi, Ueno Makoto, Moriya Satoshi, Tezuka Shun, Ohkawa Shinichi, Morinaga Soichiro, Numata Kazushi, Tanaka Katsuaki, Maeda Shin
Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center.
Department of Gastrointestinal Surgery, Kanagawa Cancer Center.
Jpn J Clin Oncol. 2017 Dec 1;47(12):1151-1156. doi: 10.1093/jjco/hyx131.
The aim of this prospective study was to evaluate the efficacy of transarterial chemoembolization using miriplatin, a platinum-based anticancer drug, as a retreatment regimen for hepatocellular carcinoma (HCC) unresponsive to chemoembolization using epirubicin.
Between April 2013 and December 2014, we enrolled 57 consecutive chamoembolization-naïve patients with unresectable HCC, and performed chemoembolization with epirubicin. Treatment effect, necrotizing rate of the target nodules, was evaluated at 1-3 months after treatment using contrast-enhanced CT or MRI. We subsequently included retreatment chemoembolization with miriplatin for patients whose treatment effect was <50% after chemoembolization with epirubicin. The treatment effect after chemoembolization with miriplatin and the liver function before and after chemoembolization were evaluated.
Eighteen patients of the 57 showed a treatment effect <50% after chemoembolization with epirubicin, and were switched to chemoembolization with miriplatin. The treatment effect after chemoembolization with miriplatin was ≥50% in four (22%) patients. Four of the remaining 14 (78%) patients who had <50% necrosis exhibited deterioration of the liver function after chemoembolization with miriplatin. Univariate analysis indicated that an alpha-fetprotein-L3 level <10% and a serum albumin level ≥3.6 g/dl were predictive factors of therapeutic response after chemoembolization with miriplatin (P < 0.05). However, there was no predictive factor regarding the deterioration of liver function after chemoembolization with miriplatin.
In unresectable HCC patients who were unresponsive to chemoembolization with epirubicin, switching the chemotherapeutic regimen to a platinum-based anticancer drug in retreatment chemoembolization should be considered as a treatment option. Trial registration: UMIN 000015887.
本前瞻性研究旨在评估使用米铂（一种铂类抗癌药物）经动脉化疗栓塞作为对表柔比星化疗栓塞无反应的肝细胞癌（HCC）再治疗方案的疗效。
2013年4月至2014年12月期间，我们连续纳入了57例初治的不可切除HCC患者，并使用表柔比星进行化疗栓塞。在治疗后1 - 3个月使用增强CT或MRI评估治疗效果，即靶结节的坏死率。随后，对于表柔比星化疗栓塞后治疗效果<50%的患者，我们纳入使用米铂进行再治疗化疗栓塞。评估米铂化疗栓塞后的治疗效果以及化疗栓塞前后的肝功能。
57例患者中有18例在表柔比星化疗栓塞后治疗效果<50%，转而接受米铂化疗栓塞。4例（22%）患者在米铂化疗栓塞后的治疗效果≥50%。其余14例坏死率<50%的患者中有4例（78%）在米铂化疗栓塞后肝功能恶化。单因素分析表明，甲胎蛋白-L3水平<10%和血清白蛋白水平≥3.6 g/dl是米铂化疗栓塞后治疗反应的预测因素（P < 0.05）。然而，对于米铂化疗栓塞后肝功能恶化没有预测因素。
对于对表柔比星化疗栓塞无反应的不可切除HCC患者，在再治疗化疗栓塞中将化疗方案转换为铂类抗癌药物应被视为一种治疗选择。试验注册：UMIN 000015887。
