Primary liver cancer in Hong Kong

From 1984 to 1987, we conducted a series of chemotherapy trials to assess their efficacy and impact on survival in patients with inoperable hepatocellular carcinoma. A total of 18 patients were treated with etoposide at a dose of 200 mg/m2 given on days 1-3 every 3 weeks for a maximum of 8 courses. No response was observed in any of the 18 patients studied. A further trial using epirubicin at doses of 40 and 75 mg/m2 again showed no evidence of a tumor response in 14 consecutive patients. The dose of epirubicin was further escalated to 90 mg/m2. Of the 33 patients treated, 1 (3%) achieved a complete response and 2 (6%) showed a partial response. Although the overall median survival amounted to only 72 days, the survival of the three responders was 15, 13, and 12 months, respectively. Therefore, we believe that the tumor response to epirubicin may be dose-dependent. However, the toxicity was also dose-dependent. To improve the therapeutic index, we are currently evaluating the impact of intrahepatic arterial injection of a lipiodol-epirubicin emulsion.