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Thalidomide in advanced hepatocellular carcinoma with optional low-dose interferon-alpha2a upon progression
Jonathan D Schwartz1, Max Sung, Myron Schwartz
1Hematology-Oncology, Mount Sinai School of Medicine, New York, New York 10029, USA. jonathan.schwartz@mssm.edu
The Oncologist
|October 27, 2005
Summary
Thalidomide showed limited disease control and poor tolerability in advanced hepatocellular carcinoma (HCC). Combining thalidomide with interferon-alpha2a (IFN-alpha2a) was not safe or effective for HCC patients.
Area of Science:
- Hepatology
- Oncology
- Pharmacology
Background:
- Systemic therapy for advanced hepatocellular carcinoma (HCC) has limited efficacy.
- Tumor angiogenesis is a recognized therapeutic target in HCC.
- Thalidomide has been investigated for its anti-angiogenic properties.
Purpose of the Study:
- To evaluate the efficacy and safety of thalidomide in patients with advanced HCC.
- To assess the combination of thalidomide and low-dose interferon-alpha2a (IFN-alpha2a) following tumor progression on thalidomide.
Main Methods:
- A study involving patients with unresectable HCC and preserved hepatic/renal function.
- Initial thalidomide dosage of 200 mg daily, adjusted for toxicity.
- Progression allowed continuation of thalidomide with added low-dose IFN-alpha2a (1 million units twice daily).
Main Results:
- Thirty-eight patients were enrolled; 60% had extrahepatic metastasis.
- Confirmed disease control in 18% (5% response rate); median progression-free survival was 2.1 months, median overall survival was 5.5 months.
- Toxicity included fatigue (74%); grade 4 arteriothrombotic events occurred in 5%. Combination therapy showed no disease control and 80% grade 3 toxicity.
Conclusions:
- Thalidomide demonstrates limited disease control and is poorly tolerated in advanced HCC.
- Combination therapy with thalidomide and low-dose IFN-alpha2a is not recommended due to lack of safety and efficacy.
- Further research into targeted therapies for advanced HCC is warranted.