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Systemic chemotherapy of liver tumors
1Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, SAR. pjjohnson@cuhk.edu.hk
Abstract:
Primary and secondary liver tumors have a reputation for being resistant to chemotherapy and, in the absence of surgical resection, rapidly fatal. Until recently, such a reputation was well justified: response rates above 20% were not seen, and complete responses were distinctly rare. Over the past 5 years, the mood of those in the field has become rather more optimistic and a pattern of effective therapy is emerging. This involves combination therapy in patients with unresectable disease to increase the operative rates, and postoperative adjuvant therapy to decrease the high relapse rate which is so characteristic of both primary and secondary liver tumors. In the case of hepatocellular carcinoma, the combination therapy involves cytotoxic drugs and interferon. With secondary colorectal cancer (CRC), the combination of 5-fluorouracil (FU) and leucovorin, together with one of the new cytotoxic agents such as oxaliplatin or irenotecan, is producing much higher response rates and prolonged survival, and permitting a higher resection rate. Postoperative treatment is also showing promise in decreasing the relapse rate. With CRC metastatic to the liver, this involves hepatic artery infusion (HAI), systemic 5-FU, and leucovorin. Adjuvant systemic therapy of HCC has not yet been widely tested, but success with locoregional lipiodol iodine131 is proof of principle. The coming decade should see a significant improvement in the outlook of patients with malignant liver tumors as multimodality treatment becomes more widely investigated and practiced.
Insights
New combination therapies are improving outcomes for liver cancer patients. Multimodality treatments offer hope for increased survival and reduced relapse rates in primary and secondary liver tumors.
Area of Science:
- Hepatology
- Medical Oncology
- Surgical Oncology
Background:
- Primary and secondary liver tumors historically show poor response to chemotherapy, often leading to rapid fatality without resection.
- Complete responses to chemotherapy were rare, and response rates rarely exceeded 20% for liver malignancies.
Purpose of the Study:
- To review emerging effective therapies for unresectable liver tumors.
- To discuss advancements in combination and adjuvant therapies for hepatocellular carcinoma and colorectal cancer metastatic to the liver.
- To highlight the potential of multimodality treatment in improving patient outcomes.
Main Methods:
- Review of current combination chemotherapy regimens for unresectable liver cancer.
- Analysis of postoperative adjuvant therapy strategies for reducing relapse rates.
- Examination of specific treatment protocols for hepatocellular carcinoma (HCC) and colorectal cancer (CRC) liver metastases.
Main Results:
- Combination therapy with cytotoxic drugs and interferon shows promise for HCC.
- For secondary CRC liver tumors, combinations of 5-fluorouracil (FU), leucovorin, and newer agents like oxaliplatin or irinotecan yield higher response rates and prolonged survival.
- Postoperative treatments, including hepatic artery infusion (HAI) and systemic 5-FU with leucovorin for CRC, and locoregional therapies like lipiodol iodine-131 for HCC, demonstrate potential in decreasing relapse rates.
Conclusions:
- Emerging combination and adjuvant therapies are significantly improving the outlook for patients with malignant liver tumors.
- Multimodality treatment strategies are becoming increasingly important and show promise for enhanced patient survival and reduced recurrence.
- Continued investigation and practice of these advanced treatment protocols are expected to drive substantial improvements in liver cancer management over the next decade.