Treatment of hepatocellular carcinoma with adriamycin. Preliminary communication

Further experience in treating patients with hepatocellular carcinoma in Uganda

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.

Chemotherapy studies in primary liver cancer: a prospective randomized clinical trial

One hundred and sixty-eight patients with unresectable primary liver cancer were prospectively studied by members of the Eastern Cooperative Oncology Group. These patients were randomized to receive treatment with oral 5-Fluorouracil (5FU), oral 5-Fu plus Streptozotocin, oral 5-Fu plus Methyl-CCNU or Adriamycin. The single agent treatments (oral 5-Fu and Adriamycin) were associated with less gastrointestinal toxicity than were the oral 5-Fu treatment combinations. A total of 15 partial responses were reported. Adriamycin appears to be the most active agent and responsible for 9 of the 15 responses. No response was seen in any of the 48 patients randomized to oral 5-Fu alone. The survival associated with oral 5-Fu alone was significantly shorter than the survival time associated with the remaining 3 treatment programs among both North American and South African patients. A multivariate model of survival was formulated. Covariates of prognostic significance were treatment, initial performance status and sex. South African black patients had a shorter survival time than North American black patients. Excluding oral 5-Fu from consideration, prognostic variables appeared to dominate any differences between the remaining treatments under study.

Intraaterial hepatic infusion and intravenous adriamycin for treatment of hepatocellular carcinoma: a clinical and pharmacology report

Four patients received intraarterial (ia) hepatic infusion and 10 received intravenous (iv) adriamycin for hepatocellular carcinoma. Four of each group are evaluable. The remaining 6 patients died within 14 days of intravenous therapy and are, therefore, considered nonevaluable. Patients received 2 to 9 courses of adriamycin every 3 weeks. One half of each group of evaluable patients had partial responses (pr). The group had pr for 22.5 weeks (range 8 to 37). The iv group had pr 27.2 weeks (range: 16 to 38.5). Mean survival was 21 weeks for nonresponders, and 43 weeks for responders. Intraarterial infusion did not protect patients from adriamycin toxicity. Cardiac and liver toxicity were not seen, but marrow and gastrointestinal toxicity developed at 1.2 X 10(-7)M adriamycin serum level. Adriamycin disappearance curves after ia and iv therapy were similar for similar bilirubin levels, and prolonged with hyperbilirubinemia. Ascites fluid did not accumulate detectable adriamycin. Pharmacokinetics are described in this report.

Complete necrotization of hepatocellular carcinoma by chemotherapy and subsequent intravascular coagulation: a case report

A 45-year-old man with hepatocellular carcinoma who developed intravascular coagulation following complete tumor regression by chemotherapy is described. After 2 doses of 10 mg of Mitomycin C given into the hepatic artery at the time of selective angiography, and 16 intravenous doses of 5-fluorouracil and Mitomycin C, 2 doses per week, subjective symptoms and hepatomegaly disappeared. Alpha-fetoprotein became negative and a remarkable change in tumor size and vasculature was noted in the arteriogram. Three months after chemotherapy, the patient developed thrombocytopenia, intravascular hemolysis, and acute renal failure. Autopsy disclosed a 8 X 7 X 5 cm solitary, encapsulated hepatocellular carcinoma in the right lobe. The tumor was surrounded by a thick capsule and completely necrotized. Neither intrahepatic invasion nor extrahepatic metastasis was observed. In the kidney, generalized fibrin thrombi were seen in the afferent arterioles of glomeruli as accounted for by intravascular coagulation.

Induction of remission in hepatocellular carcinoma with doxorubicin

Doxorubicin (60 mg/m2 at 3-weekly intervals to a maximum total of 550 mg/m2) induced clinical remission in 14 (32%) of 44 patients with hepatocellular carcinoma. In 3 of those who responded, hepatic arteriography showed clearing of the previously extensive tumour circulation, and in a 4th there was disappearance of the tumour on serial ultrasound examinations. A fall in serum-alpha-fetoprotein level after the initial injection of doxorubicin predicted a favourable clinical response, whereas the level continued to rise in patients who did not respond.

Hepatic artery ligation and adriamycin infusion chemotherapy for hepatoma

Two patients with hepatoma of the liver were treated with ligation of the hepatic artery and continuous infusion of adriamycin into the distal arterial branch. Both patients had tumor replacing 60-75% of the normal liver parenchyma. There was clinical improvement and objective shrinkage of the tumor by liver scan lasting for 5 and 7 months. But both cases died 7 and 11 months later, probably of cardiac toxicity (total dose of adriamycin = 500 mg/m2).

Techniques and therapies for primary and metastatic liver cancer

In summary, of the 460 patients of primary carcinoma of the liver admitted to the University Surgical Unit at the Queen Mary Hospital over a period of 12 years, more than 40% could not be treated, and only 91 of the patients were candidates for curative resection. The cure rate is very small; a 1- to 2-year survival was obtained in 46% of 15 resections. From 1964 to 1969, out of 22 patients with resections, 3 are still alive more than 5 year after the operation. Lin30 reported a 19.1% 5-year survival. When the hepatoma has ruptured and bleeding takes place, surgical treatment is obligatory to control the hemorrhage. Ninety-eight patients underwent a clinical trial of 5 categories: hepatic dearterialization, hepatic arterial cannulation and infusion of 5-FU, hepatic arterial ligation and portal venous infusion of 5-FU, radiotherapy and no treatment. The results show that the advantage of each form of treatment when compared with no treatment is marginal. Thus a gloomy picture of primary hepatoma is held. Since the operative mortality of hepatic resection for a solitary secondary carcinoma of the liver is negligible, it should be done in each instance because a long-term survival may be possible. This is especially true with primary carcinoma of the colon.

Chemotherapy studies in autochthonous rat tumors: hepatomas

Diethylnitrosamine (DEN) was applied orally to a total of 250 female Wistar rats in a single dose (d) of 3 mg/kg body weight 5 times a week for a duration of 20 weeks. After approximately 150 days exploratory laparotomy was performed to all animals. By inspection of the liver they were divided into 4 stages of disease according to the extent of cancer formation. The reaction of rats with DEN induced liver tumors was tested using a 4-drug combination chemotherapy with different equitoxic doses of Adriamycin (Adm), Methotrexate (Mtx), 5-Fluorouracil (5-FU) and Cyclophosphamide (CP). No benefit of drug treatment could be noted. In drug treated animals no decrease in the development of the liver tumors, in the frequency of metastases nor in the frequency of tumors of other origin could be demonstrated. The parallels of chemotherapy in chemically induced liver cancer to clinical experience are discussed.

A phase II study of adriamycin (NSC 123127) in patients with hepatocellular carcinoma from Zambia and the United States

Nineteen Zambian and 22 American patients with hepatocellular carcinoma were treated with Adriamycin every three weeks in intravenous doses ranging from 20-75 mg/m2 (depending upon their initial serum bilirubin levels). Four of 16 (25%) "good risk" Zambian and American patients who received 75 mg/m2 had objective responses, while in five additional patients there was evidence of either transient tumor regression or disease stabilization. In contrast three of 25 "poor risk" patients who received 20-60 mg/m2 had objective responses. Even in this latter group, however, transient, objective signs of tumor regression were noted in four patients. The results of the present study confirm previous reports suggesting anti-tumor activity for high doses of Adriamycin in hepatocellular carcinoma. Since those responses seen were generally incomplete and transient, further clinical trials of this agent used in combination or sequentially with other agents are indicated.