[Strategy for advanced hepatocellular carcinoma unresponsive to transcatheter arterial chemoembolization using...

Transcatheter arterial chemoembolization (TACE) has been reported to be an effective palliative treatment for patients with unresectable hepatocellular carcinoma (HCC), and many chemotherapeutic agents such as epirubicin and mitomycin C were used with lipiodol in Japan. Although repeated TACE is one of the most potent therapies for unresectable HCC, resistance to the therapy often ensues after therapy repetition, and long-term survival rates are not sufficiently high at present. Therefore, it is important to develop a new treatment strategy for HCC that has acquired resistance to TACE after therapy repetition. Platinum derivatives are effective against many malignant tumors, and in recent years, they have been used in the treatment of HCC. To our knowledge, however, there is no information of the efficacy of platinum derivatives in TACE-resistant HCC patients. In this report, we retrospectively studied 152 consecutive patients with advanced HCC resistant to TACE using epirubicin, and all cases were treated with platinum derivatives using transcatheter arterial chemotherapy. According to the results, CT at 3 months after therapy showed a "complete response (CR)" in 6 patients (4%), "partial response (PR)" in 28 (18%), and the 50% survival period was extended almost 1.4 year in PR/CR patients. A number of molecular-based chemotherapeutic agents are expected to become available in the future, and the primary therapy of advanced stage HCC may change with the introduction of these drugs. However, the results of our study suggested the advantage of using platinum derivatives in patients with TACE-resistant HCC.