4'-Epidoxorubicin (Epirubicin) as a single agent in advanced primary hepatocellular carcinoma--a preliminary...

41Epidoxorubicin (Epirubicin) is a new anthracycline analogue which has activity in a variety of cancers. Advanced primary hepatocellular carcinoma is a rapidly fatal neoplasm. Studies with doxorubicin (Adriamycin) in Africa and Asia have shown a response rate around 30-50% with modes gains in median survivals in patients who responded. We report here our preliminary experience with epirubicin in advanced primary hepatocellular carcinoma. We treated 13 patients with advanced primary hepatocellular carcinoma with epirubicin using a dose of schedule of 60 mg/m +/- at the beginning and gradually escalated to 90 mg/m +/- as tolerated. All patients had no prior chemotherapy. Median age was 51 years with range of 31 to 70 years. Cardiotoxicity was serially monitored with radionuclide multigated left ventriculogram. Objective responses were observed in 3 (23%) patients of the 13 evaluable patients. The median duration of these responders was 30 weeks (range 20 to 42). The overall median survival was 11 weeks. Two patients had cardiotoxicity as measured by a significant fall in left ventricular ejection fraction. The toxicities are much less than doxorubicin and better tolerated. We feel that epirubicin has definite activity in primary hepatocellular carcinoma even in patients with advanced disease.