Hepatic Arterial Infusion Chemotherapy with Modified FOLFOX as an Alternative Treatment Option in Advanced Hepatocellular Carcinoma Patients with Failed or Unsuitability for Transarterial Chemoembolization

Shu-Jung Hsu; Xin Xu; Mao-Pei Chen; Zhi-Ying Zhao; Yan Wang; Xin Yin; Lan Zhang; Ning-Ling Ge; Yi Chen; Yan-Hong Wang; Jian-Feng Luo; Zheng-Gang Ren; Rong-Xin Chen

doi:10.1016/j.acra.2021.01.024

Hepatic Arterial Infusion Chemotherapy with Modified FOLFOX as an Alternative Treatment Option in Advanced Hepatocellular Carcinoma Patients with Failed or Unsuitability for Transarterial Chemoembolization

Acad Radiol. 2021 Nov:28 Suppl 1:S157-S166. doi: 10.1016/j.acra.2021.01.024. Epub 2021 Feb 27.

Authors

Affiliations

¹ Liver Cancer Institute, Zhongshan Hospital, Fudan University and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China (S.J.H., X.X., M.P.C., Z.Y.Z., Y.W., X.Y., L.Z., N.L.G., Y.C., Y.H.W., Z.G.R., R.X.C.).
² Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China (J.F.L.).
³ Liver Cancer Institute, Zhongshan Hospital, Fudan University and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China (S.J.H., X.X., M.P.C., Z.Y.Z., Y.W., X.Y., L.Z., N.L.G., Y.C., Y.H.W., Z.G.R., R.X.C.). Electronic address: chen.rongxin@zs-hospital.sh.cn.

PMID: 33653656
DOI: 10.1016/j.acra.2021.01.024

Abstract

Objective: This study aimed to assess the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) with modified FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) as an alternative treatment option in advanced hepatocellular carcinoma (HCC) patients with failed or unsuitability for transarterial chemoembolization (TACE). MATERIALS AND METHODS: From September 2018 to January 2020, 87 advanced HCC patients who progressed on TACE or were not eligible for TACE received HAIC treatment with modified FOLFOX. The primary endpoint was overall survival (OS) and secondary endpoints included progression-free survival (PFS), tumor response assessed by Response Evaluation Criteria in Solid Tumors 1.1, and adverse events graded according to CTCAE 5.0. Based on prognostic factors determined by multivariate analysis, a nomogram was developed to predict patient survival.

Results: The median OS and PFS were 9.0 months (95%CI 7.6-10.4) and 3.7 months (95%CI 3.1-4.3), respectively. The objective response rate was 13.8%, with a disease control rate of 48.3%. Grade 3 adverse events were observed, such as infection (9.2%), thrombocytopenia (5.7%), hyperbilirubinemia (3.4%), abdominal pain (2.3%) and alanine aminotransferase increase (2.3%). Albumin, AST, and extrahepatic metastasis were incorporated to construct a new nomogram that could stratify patients into three prognostic subgroups, including low-, intermediate-, and high-risk groups, with significant differences in 9-month OS rates (71%, 42% and 6%, respectively; p< 0.001). The nomogram was better than the Okuda, AJCC, and CLIP staging systems for OS prediction.

Conclusion: These findings support the feasibility of HAIC with modified FOLFOX as an alternative treatment strategy for advanced HCC when TACE is ineffective or unsuitable.

Keywords: Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Transarterial chemoembolization; treatment failure; unsuitability.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Hepatocellular* / drug therapy
Carcinoma, Hepatocellular* / therapy
Chemoembolization, Therapeutic*
Fluorouracil / therapeutic use
Humans
Infusions, Intra-Arterial
Liver Neoplasms* / drug therapy
Liver Neoplasms* / therapy
Treatment Outcome

Substances

Fluorouracil