Systemic chemotherapy with epirubicin for treatment of advanced or multifocal hepatocellular carcinoma

The purpose of this retrospective study was to determine the response rate and effect on survival of chemotherapy with epirubicin in non-resectable advanced hepatocellular carcinoma (HCC).

Fifty-two patients with non-resectable disease were treated with epirubicin. A treatment cycle consisted of 20 mg/m(2) i.v. on days 1, 8 and 15 and was repeated every 4 weeks to a maximum dose of 1,000 mg/m(2). Forty-four patients were eligible for analysis.

Out of 44 patients, 1 (2.3%) achieved a complete response, 3 (6.8%) had partial responses and 16 (36%) had stable disease (SD). For patients with successful disease control (complete and partial responders and patients with SD), the median survival was 16.2 months; for non-responders, it was 6.1 months (p < 0.003). Eight (88.9%) of 9 patients with alpha-fetoprotein (AFP) levels <50 microg/l achieved successful disease control compared to 12 (34.9%) out of 35 patients with initially elevated AFP (p < 0.0001).

Epirubicin appears to be an active therapeutic option for patients with non-resectable HCC. Especially the subgroup of patients with low levels of AFP may benefit from this treatment.