[The present status of chemotherapy for hepatocellular carcinoma]

In general, chemotherapy does not play an essential role in hepatocellular carcinoma (HCC) because of the low sensitivity to antitumor agents in cancer cells. Additionally, the vast majority of patients with HCC have chronic liver disease, notably cirrhosis, so it is virtually impossible to administer a large amount of antitumor agents. In fact, chemotherapy plays an important part in multimodal treatment for HCC. Whenever chemotherapy is used for patients in the advanced stage, it should be aimed to improve prognosis without impairment of their quality of life. Regarding prognostic factors of chemotherapy for unresectable patients, both reserved hepatic function and tumor advancement are important. Intra-arterial infusion chemotherapy using MMC, ADM, CDDP and/or 5-FU via hepatic artery is appropriately used to improve the therapeutic efficacy. The response rate by one shot injection seems to be approximately 10-20% in general. Although it is not clear which medicine and means of administration are most effective, oral administration is used as a subsidiary treatment for HCC in general. In order to enhance the efficacy of antitumor agents, various drug delivery systems including selective enhancement of tumor blood flow with angiotensin II and drug carriers such as Lipiodol have been applied. Recently, totally implantable arterial access devices have been used for intermittent intra-arterial infusion chemotherapy. It seems to make life easier for the treated patients. Further trials are planned to develop new modes of chemotherapy such as overcoming multidrug resistance by calcium antagonists.