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Further experience in treating patients with hepatocellular carcinoma in Uganda
Insights
Hepatocellular carcinoma (HCC) patients in Uganda presented younger with advanced disease. Adriamycin showed moderate response rates, with intra-arterial administration and post-hepatic artery ligation potentially improving outcomes.
Area of Science:
- Oncology
- Hepatology
- Clinical Pharmacology
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Understanding treatment efficacy in diverse patient populations, such as those in sub-Saharan Africa, is crucial.
- Uganda Cancer Institute data reveals unique demographic and disease characteristics in HCC patients.
Purpose of the Study:
- To evaluate the therapeutic effectiveness of Adriamycin in treating hepatocellular carcinoma (HCC).
- To compare different administration routes (intravenous vs. intra-arterial) and combination therapies for HCC.
- To assess the impact of hepatic artery ligation (HAL) combined with Adriamycin on HCC treatment outcomes.
Main Methods:
- Retrospective analysis of 139 histologically confirmed HCC patients treated at the Uganda Cancer Institute.
- Evaluation of treatment responses to intravenous Adriamycin (n=50), intra-arterial Adriamycin, and combination therapies.
- Assessment of Adriamycin efficacy in conjunction with hepatic artery ligation (HAL).
Main Results:
- Intravenous Adriamycin achieved a 44% response rate (10% complete response) in evaluable HCC patients.
- Intra-arterial Adriamycin suggested a higher response rate (75%), potentially influenced by patient selection.
- Combination therapies did not enhance Adriamycin's effectiveness; Adriamycin post-HAL showed improved response and survival.
Conclusions:
- Adriamycin demonstrates moderate efficacy in treating HCC, with potential benefits from intra-arterial delivery and post-HAL administration.
- Combination therapies with Adriamycin did not yield superior results and may indicate drug antagonism.
- Hepatic artery ligation (HAL) is a viable palliative option, and its combination with Adriamycin warrants further investigation.
Abstract:
One hundred and thirty nine patients with histologically proven hepatocellular carcinoma (HC) were admitted to the Uganda Cancer Institute for treatment. The patients were considerably younger and seemed to have more advanced disease than HC patients in Europe and in North America. Of the 99 evaluable patients, 50 received Adriamycin intravenously; of these, 44% responded, with 10% achieving complete responses. Intraarterial Adriamycin tended to increase the response rate to 75%, but this may be merely a reflection of patient selection. Combination of Adriamycin with other drugs (dichloromethotrexate, 5-azacytidine, Rezoxane and cyclophosphamide) did not enhance its therapeutic effectiveness. The alphafetoprotein response curves observed when Adriamycin was combined with dichloromethotrexate suggested possible antagonisms between the two drugs. Hepatic artery ligation (HAL) is a good and simple palliative procedure with response rates similar to i.v. Adriamycin. However, the administration of Adriamycin after HAL tended to improve on response rates and survival. The toxicities observed were mainly myelosuppression, gastrointestinal disturbance, alopecia, and hyperpigmentation of the skin and mucous membranes.