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Treatment of hepatocellular carcinoma with octreotide: a randomised controlled study
E Kouroumalis1, P Skordilis, K Thermos
1Department of Gastroenterology, University Hospital, Crete, Greece.
Background:
Standard treatment of inoperable hepatocellular carcinoma has not been established. Somatostatin has been shown to possess antimitotic activity against a variety of non-endocrine tumours.
Aims:
To assess the presence of somatostatin receptors in human liver and to treat advanced hepatocellular carcinoma with the somatostatin analogue, octreotide.
Methods:
Somatostatin receptors were measured in liver tissue homogenates from patients with acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Fifty eight patients with advanced hepatocellular carcinoma were randomised to receive either subcutaneous octreotide 250 micrograms twice daily, or no treatment. Groups were comparable with respect to age, sex, Okuda classification, presence of cirrhosis, and liver biochemistry and virology.
Results:
Various amounts of somatostatin receptors were identified in liver tissue of all patients including those with hepatocellular carcinoma. Treated patients had an increased median survival (13 months versus four months, p = 0.002, log rank test) and an increased cumulative survival rate at six and 12 months (75% versus 37%, and 56% versus 13% respectively). Octreotide administration significantly reduced alpha fetoprotein levels at six months. When a multivariable Cox's proportional hazards model was fitted, variables associated with increased survival were: treatment administration, absence of cirrhosis, increased serum albumin, and small tumours. Treated patients clearly had a lower hazard (0.383) in the multivariate analysis.
Conclusions:
Octreotide administration significantly improves survival and is a valuable alternative in the treatment of inoperable hepatocellular carcinoma.
Insights
Octreotide, a somatostatin analogue, significantly improves survival for patients with advanced hepatocellular carcinoma (liver cancer). This treatment offers a valuable alternative for inoperable liver cancer cases.
Area of Science:
- Hepatology
- Oncology
- Endocrinology
Background:
- Standard treatment for inoperable hepatocellular carcinoma remains undefined.
- Somatostatin exhibits antimitotic properties against non-endocrine tumors.
Purpose of the Study:
- To determine the presence of somatostatin receptors in human liver tissue.
- To evaluate octreotide, a somatostatin analogue, for treating advanced hepatocellular carcinoma.
Main Methods:
- Somatostatin receptors were quantified in liver homogenates from patients with various liver conditions, including hepatocellular carcinoma.
- Fifty-eight patients with advanced hepatocellular carcinoma were randomized to receive subcutaneous octreotide or no treatment.
Main Results:
- Somatostatin receptors were detected in all liver tissue samples, including those from hepatocellular carcinoma patients.
- Octreotide treatment led to significantly increased median survival (13 vs. 4 months) and improved cumulative survival rates.
- Octreotide reduced alpha fetoprotein levels and, in multivariate analysis, was associated with a significantly lower hazard ratio for mortality.
Conclusions:
- Octreotide administration significantly enhances survival in patients with inoperable hepatocellular carcinoma.
- Octreotide represents a valuable therapeutic option for advanced, inoperable hepatocellular carcinoma.
