1
|
Wang C, Wei F, Sun X, Qiu W, Yu Y, Sun D, Zhi Y, Li J, Fan Z, Lv G, Wang G. Exploring potential predictive biomarkers through historical perspectives on the evolution of systemic therapies into the emergence of neoadjuvant therapy for the treatment of hepatocellular carcinoma. Front Oncol 2024; 14:1429919. [PMID: 38993637 PMCID: PMC11236692 DOI: 10.3389/fonc.2024.1429919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024] Open
Abstract
Hepatocellular carcinoma (HCC), a type of liver cancer, ranks as the sixth most prevalent cancer globally and represents the third leading cause of cancer-related deaths. Approximately half of HCC patients miss the opportunity for curative treatment and are then limited to undergoing systemic therapies. Currently, systemic therapy has entered the era of immunotherapy, particularly with the advent of immune-checkpoint inhibitors (ICIs), which have significantly enhanced outcomes for patients with advanced HCC. Neoadjuvant treatment for HCC has become a possibility-findings from the IMbrave 050 trial indicated that ICIs offer the benefit of recurrence-free survival for high-risk HCC patients post-resection or local ablation. However, only a small fraction of individuals benefit from systemic therapy. Consequently, there is an urgent need to identify predictive biomarkers for treatment response and outcome assessment. This study reviewed the historical progression of systemic therapy for HCC, highlighting notable therapeutic advancements. This study examined the development of systemic therapies involving conventional drugs and clinical trials utilized in HCC treatment, as well as potential predictive biomarkers for advanced and/or locally advanced HCC. Various studies have revealed potential biomarkers in the context of HCC treatment. These include the association of dendritic cells (DCs) with a favorable response to neoadjuvant therapy, the presence of enriched T effector cells and tertiary lymphoid structures, the identification of CD138+ plasma cells, and distinct spatial arrangements of B cells in close proximity to T cells among responders with locally advanced HCC receiving neoadjuvant cabozantinib and nivolumab treatment. Furthermore, pathological response has been associated with intratumoral cellular triads consisting of progenitor CD8+ T cells and CXCL13+ CD4+ T helper cells surrounding mature DCs in patients receiving neoadjuvant cemiplimab for resectable HCC. Despite no widely recognized predictive biomarkers for HCC individualized treatment, we believe neoadjuvant trials hold the most promise in identifying and validating them. This is because they can collect multiple samples from resectable HCC patients across stages, especially with multi-omics, bridging preclinical and clinical gaps.
Collapse
Affiliation(s)
- Chuanlei Wang
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Feng Wei
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Xiaodong Sun
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Wei Qiu
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Ying Yu
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Dawei Sun
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Yao Zhi
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Jing Li
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Zhongqi Fan
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Guoyue Lv
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| | - Guangyi Wang
- Department of Hepatobiliary and Pancreatic Surgery I, General Surgery Center, The First Hospital of Jilin University, Changchun, China
- Key Laboratory of the General Surgery Health Department of Jilin Province, Changchun, China
| |
Collapse
|
2
|
Bruix J. A history of the treatment of primary liver cancer. Clin Liver Dis (Hoboken) 2024; 23:e0147. [PMID: 38707239 PMCID: PMC11068144 DOI: 10.1097/cld.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/23/2023] [Indexed: 05/07/2024] Open
|
3
|
Sobnach S, Kotze U, Spearman CW, Sonderup M, Nashidengo PR, Ede C, Keli E, Chihaka O, Zerbini LF, Li YJ, Gandhi K, Krige J, Jonas E. The management and outcomes of hepatocellular carcinoma in sub-Saharan Africa: a systematic review. HPB (Oxford) 2024; 26:21-33. [PMID: 37805364 DOI: 10.1016/j.hpb.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a leading cause of mortality in sub-Saharan Africa (SSA). This systematic review aimed to appraise all population-based studies describing the management and outcomes of HCC in SSA. METHODS A systematic review based on a search in PubMed, PubMed Central, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AfricaWide and Cochrane up to June 2023 was performed. PRISMA guidelines for systematic reviews were followed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration no: CRD42022363955). RESULTS Thirty-nine publications from 15 of 48 SSA countries were identified; 3989 patients were studied. The majority (74%) were male, with median ages ranging from 28 to 54 years. Chronic Hepatitis B infection was a leading aetiology and non-cirrhotic HCC was frequently reported. Curative treatment (liver resection, transplantation and ablation) was offered to 6% of the cohort. Most patients (84%) received only best supportive care (BSC), with few survivors at one year. CONCLUSION The majority of SSA countries do not have data reporting outcomes for HCC. Most patients receive only BSC, and curative treatment is seldom available in the region. Outcomes are poor compared to high-income countries.
Collapse
Affiliation(s)
- Sanju Sobnach
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa.
| | - Urda Kotze
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Pueya R Nashidengo
- Department of Surgery, Windhoek Central Hospital, University of Namibia School of Medicine, Windhoek, Namibia
| | - Chikwendu Ede
- Netcare Alberton Hospital, Johannesburg, South Africa
| | - Elie Keli
- Department of General and Digestive Surgery, Hôpital Militaire d'Abidjan, Abidjan, Republic of Côte d'Ivoire
| | - Onesai Chihaka
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - Luiz F Zerbini
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town, South Africa
| | - Yifan J Li
- Department of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Karan Gandhi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Jake Krige
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Eduard Jonas
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
4
|
Unresectable Hepatocellular Carcinoma: A Review of New Advances with Focus on Targeted Therapy and Immunotherapy. LIVERS 2023. [DOI: 10.3390/livers3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
With an expected incidence of more than 1 million cases by 2025, liver cancer remains a problem for world health. With over 90% of cases, hepatocellular carcinoma (HCC) is the most prevalent kind of liver cancer. In this review, we presented the range of experimental therapeutics for patients with advanced HCC, the successes and failures of new treatments, areas for future development, the evaluation of dose-limiting toxicity in different drugs, and the safety profile in patients with liver dysfunction related to the underlying chronic liver disease. In addition to the unmet demand for biomarkers to guide treatment decisions and the burgeoning fields of immunotherapy and systemic therapy in hepatocellular carcinoma, the development of old and new drugs, including their failures and current advancements, has been reviewed. This review aims to evaluate the updated optimal clinical treatment of unresectable hepatocellular carcinomas in clinical practice, mainly through targeted therapy. Although surgical treatment can significantly enhance the survival probability of early and intermediate-stage patients, it is unsuitable for most HCC patients due to a lack of donors. Due to their severe toxicity, the few first-line anti-HCC drugs, such as sorafenib, are often reserved for advanced HCC patients for whom other therapies have failed. The second-line drugs are usually alternatives for patients with intolerance or resistance. Consequently, the ongoing growth of possible preclinical drugs and studies on miRNAs, lncRNAs, and numerous other signaling pathway targets for developing novel drugs may introduce additional treatment prospects for HCC.
Collapse
|
5
|
Tsao SY. Perspectives of traditional Chinese medicine to patch up immune checkpoint blockers. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2022; 3:676-693. [PMCID: PMC9630551 DOI: 10.37349/etat.2022.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
In this era of cancer immunotherapy, the response rates of immune checkpoint blockers (ICBs) are still too low and the adverse events may also be significant. Of the ways of patching up such deficits, chemotherapy (ChT), especially if metronomic, seems promising, especially as immunity induced by immunogenic cell death (ICD) may be preserved. However, side effects, e.g., lymphocytopenia and interstitial pneumonitis cannot be ignored; eventually, resistance may also ensue. Vascular endothelial growth factors (VEGFs), being potent angiogenic factors, promote cancer cells’ purposeful angiogenesis rendering an extremely resistant tumor microenvironment (TME). This highly evasive and extremely resilient TME actually demands multi-agent, multi-target agents as currently in use through traditional Chinese medicine (TCM). With a good track record of 3,000 years, TCM is favored by mainland Chinese cancer patients. Although TCM had been criticized as unscientific and imprecise, recently, artificial intelligence (AI) technologies serve to elucidate the sound scientific basis and validity of TCM. Several TCM preparations having anti-VEGF actions are found; others suppress immune checkpoints. Especially, these herbs’ multi-prong approach appears to be more effective than Western medicine’s primarily monotherapy approach if one wishes to eradicate the very resistant TME. A “bonus” point is that some autoimmune-related adverse side effects of ICBs may also be reduced by TCM. Nevertheless, as the TCM experience is mostly anecdotal, robust clinical trials are mandatory. Moreover, other TCM problems, e.g., herbal batch variations and consistency and uniformity of herbal prescriptions are outstanding. Invariably, TCM prescriptions have daily variations as the practice of “syndrome differentiation” is hailed. Despite experienced TCM practitioners would refuse to give up their time-honored traditional practice, the multi-prong approach is still very attractive for the undue resilience of TME, let alone its good safety profile, ready availability, and eminent affordability. Although the passage is dark, light is now appearing at the end of the tunnel.
Collapse
Affiliation(s)
- Shiu Ying Tsao
- Department of Clinical Research, Hong Kong SAR Oncology Centre, Hong Kong SAR 999077, China
| |
Collapse
|
6
|
Fan W, Zhu B, Yue S, Zheng X, Zou X, Li F, Qiao L, Wu Y, Xue M, Wang H, Tang Y, Li J. Idarubicin-Loaded DEB-TACE plus Lenvatinib versus Lenvatinib for patients with advanced hepatocellular carcinoma: A propensity score-matching analysis. Cancer Med 2022; 12:61-72. [PMID: 35698292 PMCID: PMC9844616 DOI: 10.1002/cam4.4937] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS To investigate the efficacy and safety of lenvatinib and idarubicin-loaded drug-eluting beads transarterial chemoembolization (IDADEB-TACE) in primary advanced hepatocellular carcinoma (HCC). METHODS This retrospective study included patients with primary advanced HCC who received either lenvatinib monotherapy or lenvatinib plus IDADEB-TACE as first-line treatment from September 2019 to September 2020 at three institutes. Overall survival (OS), time to progression (TTP), objective response rate (ORR), and adverse events were compared. Propensity score-matching was used to reduce the influence of confounding factors on the outcomes. RESULTS The study reviewed 118 patients who received lenvatinib plus IDADEB-TACE (LIDA group) and 182 who received lenvatinib alone (LEN group). After propensity score-matching, 78 pairs of patients remained. Compared to patients in the LEN group, those in the LIDA group had better post-treatment ORR (57.7% vs. 25.6%, p < 0.001, respectively), median OS and TTP (15.7 vs. 11.3 months, hazard ratio [HR] = 0.50, p < 0.001; 8.0 vs. 5.0 months, HR = 0.60, p = 0.003, respectively), 6- and 12-month OS rates (88.5% vs. 71.4%; 67.6% vs. 43.4%, respectively), and progression-free rates at 6 and 12 months (60.3% vs. 42.3%; 21.1% vs. 10.3%, respectively). Vascular invasion, α-fetoprotein level, and treatment type were independent OS predictors, and vascular invasion and treatment type were independent TTP predictors. Incidences of nausea/vomiting, fever, abdominal pain, and increased ALT/AST were higher in the LIDA group than in the LEN group. CONCLUSIONS Lenvatinib plus IDADEB-TACE is well-tolerated and more effective than lenvatinib monotherapy in patients with advanced HCC.
Collapse
Affiliation(s)
- Wenzhe Fan
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Bowen Zhu
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Shufan Yue
- Department of UltrasonicSun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Xinlin Zheng
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Xinhua Zou
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Fuliang Li
- Liver and Gall Surgical DepartmentGaozhou People's HospitalGaozhouChina
| | - Liangliang Qiao
- Department of OncologyJinshazhou Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Yanqin Wu
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Miao Xue
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Hongyu Wang
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Yiyang Tang
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Jiaping Li
- Department of Interventional OncologySun Yat‐sen University First Affiliated HospitalGuangzhouChina
| |
Collapse
|
7
|
Falette Puisieux M, Pellat A, Assaf A, Ginestet C, Brezault C, Dhooge M, Soyer P, Coriat R. Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review. Cancers (Basel) 2022; 14:cancers14102357. [PMID: 35625962 PMCID: PMC9139863 DOI: 10.3390/cancers14102357] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) usually occurs in the setting of liver cirrhosis and more rarely in a healthy liver. Its incidence has increased in the past years, especially in western countries with the rising prevalence of non-alcoholic fatty liver disease. The prognosis of advanced HCC is low. In the first-line setting of advanced HCC, sorafenib, a tyrosine kinase inhibitor, was the only validated treatment for many years. In 2020, the combination of atezolizumab, an immune checkpoint inhibitor, and bevacizumab showed superiority to sorafenib alone in survival, making it the first-line recommended treatment. Regorafenib and lenvatinib, other multikinase inhibitors, were also validated in the second and first-line settings, respectively. Transarterial chemoembolization can be an alternative treatment for patients with intermediate-stage HCC and preserved liver function, including unresectable multinodular HCC without extrahepatic spread. The current challenge in advanced HCC lies in the selection of a patient for the optimal treatment, taking into account the underlying liver disease and liver function. Indeed, all trial patients present with a Child-Pugh score of A, and the optimal approach for other patients is still unclear. Furthermore, the combination of atezolizumab and bevacizumab should be considered in the absence of medical contraindication. Many trials testing immune checkpoint inhibitors in association with anti-angiogenic agents are ongoing, and primary results are promising. The landscape in advanced HCC management is undergoing profound change, and many challenges remain for optimal patient management in the years to come. This review aimed to provide an overview of current systemic treatment options for patients with advanced unresectable HCC who are not candidates for liver-directed therapy.
Collapse
Affiliation(s)
- Manon Falette Puisieux
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
- Correspondence: ; Tel.: +33-1-58-41-19-52
| | - Anna Pellat
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Antoine Assaf
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Claire Ginestet
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Catherine Brezault
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Marion Dhooge
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Philippe Soyer
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
- Radiology Department, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (A.A.); (C.G.); (C.B.); (M.D.); (R.C.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| |
Collapse
|
8
|
Menon MP, Niyonzima N, Gralow J, Orem J. Breast Cancer Clinical Trials: The Landscape at the Uganda Cancer Institute and Lessons Learned. JCO Glob Oncol 2021; 7:127-132. [PMID: 33449804 PMCID: PMC8081514 DOI: 10.1200/go.20.00185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Uganda Cancer Institute, the sole national comprehensive cancer center in Uganda, has a long and rich history of clinical investigation and locally relevant cancer research. Given the increasing burden of breast cancer in Uganda and elsewhere in sub-Saharan Africa (SSA) and driven by the limited availability of immunohistochemistry (IHC), we launched a clinical trial aimed at evaluating locally available diagnostics to detect the presence of hormone receptors (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2. Preliminary data from 32 women in the diagnostic component of the study reveal high sensitivity and specificity for estrogen receptor and progesterone receptor and high specificity for human epidermal growth factor receptor 2 when comparing reverse transcriptase polymerase chain reaction with the gold standard (IHC). Innovative diagnostic and treatment strategies are required to address the burden of breast cancer that is increasing throughout SSA. Given the costs, infrastructure, and trained personnel associated with IHC, alternative testing options (including reverse transcriptase polymerase chain reaction as tested in our study) may provide an expedited and cost-effective method to determine receptor testing in breast cancer. Clinical trials conducted in the local setting are critical to determining optimal strategies for effective breast cancer management in SSA.
Collapse
Affiliation(s)
- Manoj P Menon
- Fred Hutchinson Cancer Research Center, Seattle, WA.,University of Washington, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Nixon Niyonzima
- Fred Hutchinson Cancer Research Center, Seattle, WA.,Uganda Cancer Institute, Kampala, Uganda
| | - Julie Gralow
- Fred Hutchinson Cancer Research Center, Seattle, WA.,University of Washington, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | | |
Collapse
|
9
|
Xiong Q, Bai Y, Shi R, Wang J, Xu W, Zhang M, Song T. Preferentially released miR-122 from cyclodextrin-based star copolymer nanoparticle enhances hepatoma chemotherapy by apoptosis induction and cytotoxics efflux inhibition. Bioact Mater 2021; 6:3744-3755. [PMID: 33898875 PMCID: PMC8056416 DOI: 10.1016/j.bioactmat.2021.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/12/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy, as one of the most commonly used treatment modalities for cancer therapy, provides limited benefits to hepatoma patients, owing to its inefficient delivery as well as the intrinsic chemo-resistance of hepatoma. Bioinformatic analysis identified the therapeutic role of a liver-specific microRNA — miR-122 for enhancing chemo-therapeutic efficacy in hepatoma. Herein, a cyclodextrin-cored star copolymer nanoparticle system (sCDP/DOX/miR-122) is constructed to co-deliver miR-122 with doxorubicin (DOX) for hepatoma therapy. In this nanosystem, miR-122 is condensed by the outer cationic poly (2-(dimethylamino) ethyl methacrylate) chains of sCDP while DOX is accommodated in the inner hydrophobic cyclodextrin cavities, endowing a sequential release manner of miR-122 and DOX. The preferentially released miR-122 not only directly induces cell apoptosis by down regulation of Bcl-w and enhanced p53 activity, but also increases DOX accumulation through inhibiting cytotoxic efflux transporter expression, which realizes synergistic performance on cell inhibition. Moreover, sCDP/DOX/miR-122 displays remarkably increased anti-tumor efficacy in vivo compared to free DOX and sCDP/DOX alone, indicating its great promising in hepatoma therapy. Cyclodextrin-based polymeric nanoparticle was developed to co-deliver miR-122 and doxorubicin. The nanoparticle sequentially released miR-122 and doxorubicin into HepG2 cells. The preferentially released miR-122 induces cell apoptosis and inhibits doxorubicin efflux. Enhanced anti-tumor effects with reduced cardiotoxicity were achieved in vivo.
Collapse
Affiliation(s)
- Qingqing Xiong
- Department of Hepatobiliary Cancer, Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, PR China
- Corresponding author.
| | - Yang Bai
- Department of Hepatobiliary Cancer, Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, PR China
| | - Run Shi
- Faculty of Medicine, Ludwig-Maximilians-Universität München, München, D-80333, Germany
| | - Jian Wang
- Department of Immunology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, PR China
| | - Weiguo Xu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, PR China
| | - Mingming Zhang
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, PR China
- Corresponding author.
| | - Tianqiang Song
- Department of Hepatobiliary Cancer, Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, PR China
- Corresponding author.
| |
Collapse
|
10
|
Guiu B, Assenat E. Doxorubicin for the treatment of hepatocellular carcinoma: GAME OVER! ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1693. [PMID: 33490205 PMCID: PMC7812160 DOI: 10.21037/atm-2020-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Eric Assenat
- Department of Oncology, St-Eloi University Hospital, Montpellier, France
| |
Collapse
|
11
|
Chagas AL, Mattos AAD, Carrilho FJ, Bittencourt PL, Vezozzo DCP, Horvat N, Rocha MDS, Alves VAF, Coral GP, Alvares-DA-Silva MR, Barros FMDR, Menezes MR, Monsignore LM, Coelho FF, Silva RFD, Silva RDCMA, Boin IDFSF, D Albuquerque LAC, Garcia JHP, Felga GEG, Moreira AM, Braghiroli MIFM, Hoff PMG, Mello VBD, Dottori MF, Branco TP, Schiavon LDL, Costa TDFA. BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR DIAGNOSIS AND TREATMENT OF HEPATOCELLULAR CARCINOMA. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:1-20. [PMID: 32294682 DOI: 10.1590/s0004-2803.202000000-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.
Collapse
Affiliation(s)
- Aline Lopes Chagas
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Angelo Alves de Mattos
- Universidade Federal de Ciências da Saúde de Porto Alegre e Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Flair José Carrilho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | | | | - Natally Horvat
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Manoel de Souza Rocha
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Venâncio Avancini Ferreira Alves
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | - Gabriela Perdomo Coral
- Universidade Federal de Ciências da Saúde de Porto Alegre e Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | | | - Marcos Roberto Menezes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil.,Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - Lucas Moretti Monsignore
- Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, SP, Brasil
| | | | - Renato Ferreira da Silva
- Faculdade de Medicina de São José do Rio Preto (FAMERP) e Hospital de Base de São José do Rio Preto (FUNFARME), São José do Rio Preto, SP, Brasil
| | - Rita de Cássia Martins Alves Silva
- Faculdade de Medicina de São José do Rio Preto (FAMERP) e Hospital de Base de São José do Rio Preto (FUNFARME), São José do Rio Preto, SP, Brasil
| | | | | | | | | | - Airton Mota Moreira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | - Paulo Marcelo Gehm Hoff
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | | - Tiago Pugliese Branco
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil
| | | | | |
Collapse
|
12
|
Guiu B, Colombat S, Piron L, Hermida M, Allimant C, Pierredon-Foulongne MA, Belgour A, Escal L, Cassinotto C, Boulin M. Transarterial Chemoembolization of Hepatocellular Carcinoma with Idarubicin-Loaded Tandem Drug-Eluting Embolics. Cancers (Basel) 2019; 11:E987. [PMID: 31311170 PMCID: PMC6678754 DOI: 10.3390/cancers11070987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/07/2019] [Accepted: 07/13/2019] [Indexed: 12/15/2022] Open
Abstract
: Objective: To describe the responses, toxicities and outcomes of HCC patients treated by transarterial chemoembolization (TACE) using idarubicin-loaded TANDEM beads. Materials and Methods: Seventy-two consecutive patients (mean age: 71 years (58-84 years)) with HCC were treated by TACE using idarubicin-loaded TANDEM in a first line, over a five-year period. Most patients (89%) had liver cirrhosis classified as Child-Pugh A (90%). BCLC B classification applied in 85% of cases. Baseline tumor burden was limited to one to three nodules in 92% of cases, unilobar in 88% cases, with a median tumor diameter of 55 mm (range: 13-150 mm). Toxicity was assessed using NCI CTC AE v4.0. Response was assessed using mRECIST criteria. Time-to-treatment failure (TTTF) and overall survival (OS) were also calculated based on Kaplan-Meier method. Result: Of 141 TACE sessions performed with bead sizes of 100 and 75 µm in 42 (29.8%) and 99 (70.2%) sessions, respectively. In 78% of all TACE sessions, the full dose of idarubicin-loaded beads was injected. Grade 3-4 AE were observed after 73 (52%) sessions, most of them being biological. Multi-organ failure was observed three days after the first TACE in a Child B patients, unfortunately leading to death. Overall, the best objective response rate (ORR) was 65%. Median follow-up lasted 14.3 months (95% CI: 11.2-18.8 months). Median TTTF and OS were 14.4 months (95% CI: 7.2-24.6 months) and 34.6 months (95% CI: 24.7-not reached) respectively. Conclusion: In this retrospective study involving well-selected HCC patients, high ORR and long TTTF and OS are observed after TACE using idarubicin-loaded TANDEM. A randomized trial is needed.
Collapse
Affiliation(s)
- Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France.
| | | | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Margaux Hermida
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Carole Allimant
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | | | - Ali Belgour
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Laure Escal
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | | | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital, 21000 Dijon, France
| |
Collapse
|
13
|
Guiu B, Chevallier P, Assenat E, Barbier E, Merle P, Bouvier A, Dumortier J, Nguyen-Khac E, Gugenheim J, Rode A, Oberti F, Valette PJ, Yzet T, Chevallier O, Barbare JC, Latournerie M, Boulin M. Idarubicin-loaded Beads for Chemoembolization of Hepatocellular Carcinoma: The IDASPHERE II Single-Arm Phase II Trial. Radiology 2019; 291:801-808. [PMID: 31038408 DOI: 10.1148/radiol.2019182399] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background A prior in vitro study showed that idarubicin was the most cytotoxic agent for hepatocellular carcinoma (HCC) cell lines. Idarubicin-loaded beads for transarterial chemoembolization (TACE) were previously evaluated for the appropriate dose in a phase I dose-escalation study. Purpose To evaluate objective response rate (ORR), safety, and survival after TACE by using idarubicin-loaded beads for unresectable HCC. Materials and Methods This prospective single-arm phase II study was conducted between January 2015 and January 2017. Participants with unresectable HCC were included in the trial and underwent TACE with idarubicin-eluting beads. The primary end point was 6-month ORR assessed with independent central review by using modified Response Evaluation Criteria in Solid Tumors. Secondary end points were best ORR during the first 6 months, overall survival, progression-free survival, time to progression, and safety. A two-stage Fleming statistical design was used. Results Forty-six study participants (mean age, 71.2 years ± 10.2; six women and 40 men) were included; 44 participants underwent at least one TACE session. The 6-month ORR was 52% (23 of 44). The best ORR achieved was 68% (30 of 44). Fourteen of 44 (32%) participants underwent a curative treatment after TACE. Median progression-free survival, time to progression, and overall survival were 6.6 months, 9.5 months, and 18.6 months, respectively. TACE was discontinued for toxicity in four of 44 (9%) participants. The most frequent grade 3-4 adverse events were elevated aspartate aminotransferase (14 of 44, 32%), elevated γ-glutamyl transpeptidase (eight of 44, 18%), hyperbilirubinemia (seven of 44, 16%), elevated alanine aminotransferase (seven of 44, 16%), and pain (seven of 44, 16%). Conclusion Idarubicin-eluting beads showed a good safety profile and promising objective response rate and time to progression when used as part of a transarterial chemoembolization regimen for unresectable hepatocellular carcinoma. © RSNA, 2019 See also the editorial by Padia in this issue.
Collapse
Affiliation(s)
- Boris Guiu
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Patrick Chevallier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Eric Assenat
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Emilie Barbier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Philippe Merle
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Antoine Bouvier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jérôme Dumortier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Eric Nguyen-Khac
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jean Gugenheim
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Agnès Rode
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Frédéric Oberti
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Pierre-Jean Valette
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Thierry Yzet
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Olivier Chevallier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jean-Claude Barbare
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Marianne Latournerie
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Mathieu Boulin
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| |
Collapse
|
14
|
Systemic Management for Advanced Hepatocellular Carcinoma: A Review of the Molecular Pathways of Carcinogenesis, Current and Emerging Therapies, and Novel Treatment Strategies. Dig Dis Sci 2019; 64:1016-1029. [PMID: 30887150 DOI: 10.1007/s10620-019-05582-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) arises from a number of cirrhosis-related and non-cirrhosis-related exposures and is one of the leading causes of cancer-related deaths worldwide. Achieving a durable cure currently relies on either resection or transplantation, but since most patients will be diagnosed with inoperable disease, there is great interest in achieving more effective systemic therapies. At a molecular level, HCC is heterogeneous, but initial treatment strategies, including the use of multi-targeted tyrosine kinase inhibitors and checkpoint inhibitors, have been fairly homogenous, depending on general host factors and overall tumor burden rather than specific molecular signatures. Over the past 2 decades, however, there has been significant success in identifying key molecular targets, including driver mutations involving the telomerase reverse transcriptase, p53, and beta-catenin genes, and significant work is now being devoted to translating these discoveries into the development of robust and well-tolerated targeted therapies. Furthermore, multi-modal therapies have also begun to emerge, harnessing possible synergism amongst a variety of different treatment classes. As the findings of these landmark trials become available over the next several years, the landscape of the systemic management of advanced HCC will change significantly.
Collapse
|
15
|
Delicque J, Guiu B, Boulin M, Schwanz H, Piron L, Cassinotto C. Liver chemoembolization of hepatocellular carcinoma using TANDEM ® microspheres. Future Oncol 2018; 14:2761-2772. [PMID: 29953255 DOI: 10.2217/fon-2018-0237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Transarterial chemoembolization (TACE) combines intra-arterial delivery of a chemotherapeutic agent with selective embolization to obtain a synergistic effect. TACE is recognized as the standard treatment of hepatocellular carcinoma patients at an intermediate stage. If conventional TACE, defined as the injection of an emulsion of a drug with ethiodized oil, still has a role to play, the development of drug-eluting beads has allowed many improvements and optimization of the technique. TANDEM® microspheres are second-generation drug-loadable microspheres. This device raised a special interest due to its tightly calibrated spherical microspheres, with small sizes down to 40 μm available. In this review, we describe the technical characteristics of these microspheres, analyze the scientific literature and hypothesize on the future perspectives.
Collapse
Affiliation(s)
- Julien Delicque
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France.,INSERM U1194, Montpellier Cancer Research Institute, 34298 Montpellier, France
| | - Mathieu Boulin
- Department of Pharmacy, University Hospital of Dijon, 21000 Dijon, France
| | | | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | | |
Collapse
|
16
|
Eatrides J, Wang E, Kothari N, Kim R. Role of Systemic Therapy and Future Directions for Hepatocellular Carcinoma. Cancer Control 2018; 24:1073274817729243. [PMID: 28975834 PMCID: PMC5937243 DOI: 10.1177/1073274817729243] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive tumor that often arises in the setting of liver cirrhosis. Although early-stage disease is often amenable for surgical resection, transplant, or locoregional therapies, many patients are diagnosed at an advanced stage or have poor liver reserve. Systemic therapy is the mainstay of treatment for these patients. At present, the only approved therapy for the treatment of advanced disease is the tyrosine multikinase inhibitor sorafenib. Candidacy for treatment is based on liver reserve. Novel agents for the treatment of this disease are urgently needed. In this article, we review systemic therapy trials and upcoming data for the treatment of HCC.
Collapse
Affiliation(s)
- Jennifer Eatrides
- 1 Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Emilie Wang
- 1 Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Nishi Kothari
- 1 Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Richard Kim
- 1 Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| |
Collapse
|
17
|
Colleoni M, Gaion F, Liessi G, Mastropasqua G, Nelli P, Manente P. Medical Treatment of Hepatocellular Carcinoma: Any Progress? TUMORI JOURNAL 2018; 80:315-26. [PMID: 7839458 DOI: 10.1177/030089169408000501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Hepatocellular carcinoma (HCC) remains one of the most common neoplasms worldwide. Curative treatment options include liver transplantation or resection. Unfortunately, most patients still have unresectable or untransplantable HCC due to disease extension or comorbid factors and are therefore candidate only for palliative treatments. Methods In this review we have analyzed the different medical approaches employed in the treatment of HCC in an attempt to better define their roles. Results Palliative medical treatments including systemic chemotherapy, immunotherapy or hormonal manipulation rarely influence survival of the patients. Although a high response rate is often reported with new local therapies such as transcatheter arterial embolization, intraarterial chemotherapy or percutaneous ethanol injection, the real impact of these treatment modalities on patient survival remains to be determined. Conclusion One way to improve the diagnosis of HCC patients would be an appropriate approach to evaluate new drugs or treatment modalities. To answer all the open questions, further trials, possibly randomized, should be conducted on a substantial number of patients with homogeneous prognostic factors.
Collapse
Affiliation(s)
- M Colleoni
- Department of Medical Oncology, Ospedale Civile, Castelfranco Veneto, Italy
| | | | | | | | | | | |
Collapse
|
18
|
FSCN‑1 increases doxorubicin resistance in hepatocellular carcinoma through promotion of epithelial-mesenchymal transition. Int J Oncol 2018; 52:1455-1464. [PMID: 29568938 PMCID: PMC5873898 DOI: 10.3892/ijo.2018.4327] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/20/2018] [Indexed: 01/25/2023] Open
Abstract
Resistance to chemotherapy drugs remains a significant problem for the treatment of many types of cancer. Fascin-1 (FSCN-1) is an actin-bundling protein involved in the invasion and metastasis of a variety of tumors. However, its involvement in drug resistance in hepatocellular carcinoma (HCC) remains unclear. The present study aimed to investigate the function of FSCN-1 in HCC resistance to doxorubicin (DOX). FSCN-1 expression was increased in DOX-resistant HCC cell lines (SNU449 and SNU387) compared with DOX-sensitive cell lines (Huh7 and Hep3B). The resistance of HCC cells to DOX was decreased following FSCN-1 knockdown with small interfering RNA. FSCN-1 knockdown also significantly altered the expression of key markers of epithelial-mesenchymal transition (EMT). Notably, vimentin expression was reduced and epithelial-cadherin expression was increased. Furthermore, when EMT was suppressed through knockdown of Twist, an essential pathway of DOX-induced EMT, the viability of HCC cells following treatment with DOX was not affected by FSCN-1 expression. Furthermore, FSCN-1 knockdown eliminated hypoxia-induced doxorubicin resistance and EMT. The results of the present study indicated that FSCN-1 expression increased DOX resistance in HCC cells via the promotion of EMT, and this phenomenon was maintained in a hypoxic environment. FSCN-1 potentially represents a novel target to overcome resistance to DOX in HCC.
Collapse
|
19
|
Alteration of SHP-1/p-STAT3 Signaling: A Potential Target for Anticancer Therapy. Int J Mol Sci 2017; 18:ijms18061234. [PMID: 28594363 PMCID: PMC5486057 DOI: 10.3390/ijms18061234] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/12/2022] Open
Abstract
The Src homology 2 (SH2) domain-containing protein tyrosine phosphatase 1 (SHP-1), a non-receptor protein tyrosine phosphatase, has been reported as a negative regulator of phosphorylated signal transducer and activator of transcription 3 (STAT3) and linked to tumor development. In this present review, we will discuss the importance and function of SHP-1/p-STAT3 signaling in nonmalignant conditions as well as malignancies, its cross-talk with other pathways, the current clinical development and the potential role of inhibitors of this pathway in anticancer therapy and clinical relevance of SHP-1/p-STAT3 in cancers. Lastly, we will summarize and highlight work involving novel drugs/compounds targeting SHP-1/p-STAT3 signaling and combined strategies that were/are discovered in our and our colleagues’ laboratories.
Collapse
|
20
|
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer with poor prognosis. The incidence of HCC and HCC-related deaths have increased over the last several decades. However, the treatment options for advanced HCC are very limited. Sorafenib remains the only drug approved for systemic treatment for advanced HCC. However, prior to sorafenib era conventional cytotoxic chemotherapies have been studied in advanced HCC. In this review, clinical studies of systemic chemotherapy for advanced HCC will be summarized and discussed.
Collapse
Affiliation(s)
- Dae Won Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Chetasi Talati
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Richard Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| |
Collapse
|
21
|
Boulin M, Guiu B. Chemoembolization or Bland Embolization for Hepatocellular Carcinoma: The Question Is Still Unanswered. J Clin Oncol 2016; 35:256-257. [PMID: 28056196 DOI: 10.1200/jco.2016.67.2915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mathieu Boulin
- Mathieu Boulin, University Hospital, Dijon, France; and Boris Guiu, Saint-Eloi University Hospital, Montpellier, France
| | - Boris Guiu
- Mathieu Boulin, University Hospital, Dijon, France; and Boris Guiu, Saint-Eloi University Hospital, Montpellier, France
| |
Collapse
|
22
|
Nguyen K, Jack K, Sun W. Hepatocellular Carcinoma: Past and Future of Molecular Target Therapy. Diseases 2015; 4:E1. [PMID: 28933381 PMCID: PMC5456309 DOI: 10.3390/diseases4010001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer related mortality worldwide. The incidence of HCC has been increasing annually. Viral infection, alcohol usage, and other causes of cirrhosis have been identified as major risk factors for HCC development. The underlying pathogenesis has not been as well defined. There have been multiple hypotheses to the specific mechanisms of hepatocarcinogenesis and they share the common theme of chronic inflammation, increase oxidative stress, and genomic alteration. Therapeutic options of HCC have been primarily local and/or regional including transplantation, resection, and radial frequency ablation, chemoembolization or radio-embolization. For unresectable or metastatic disease, the options are limited. Conventional chemotherapeutic options have been noted to have limited benefit. Sorafenib has been the one and only systemic therapy which has demonstrated modest overall survival benefit. This has led to more extensive research with focus on targeted therapy. Numerous pre-clinical and early phase clinical studies have been noted but failed to show efficacy in later phase clinical trials. In an effort to identify new potential therapeutic options, new understanding of underlying pathways to hepatocarcinogenesis should be one of the main focuses. This leads to development of more molecularly targeted agents to specific pathways, and immunotherapy. This article provides a review of major studies of molecular targeted agents which attempts to target these specific pathways in HCC.
Collapse
Affiliation(s)
- Khanh Nguyen
- University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 5150 Center Ave. 5th floor, Pittsburgh, PA 15232, USA.
| | - Kerri Jack
- University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 5150 Center Ave. 5th floor, Pittsburgh, PA 15232, USA.
| | - Weijing Sun
- University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, 5150 Center Ave. 5th floor, Pittsburgh, PA 15232, USA.
| |
Collapse
|
23
|
Personalized Chemotherapy for Hepatocellular Carcinoma. AN INFORMATION TECHNOLOGY FRAMEWORK FOR PREDICTIVE, PREVENTIVE AND PERSONALISED MEDICINE 2015. [DOI: 10.1007/978-3-319-12166-6_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
24
|
Guiu B, Schmitt A, Reinhardt S, Fohlen A, Pohl T, Wendremaire M, Denys A, Blümmel J, Boulin M. Idarubicin-loaded ONCOZENE drug-eluting embolic agents for chemoembolization of hepatocellular carcinoma: in vitro loading and release and in vivo pharmacokinetics. J Vasc Interv Radiol 2014; 26:262-70. [PMID: 25311967 DOI: 10.1016/j.jvir.2014.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present in vitro loading and release characteristics of idarubicin with ONCOZENE (CeloNova BioSciences, Inc, San Antonio, Texas) drug-eluting embolic (DEE) agents and in vivo pharmacokinetics data after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in patients with hepatocellular carcinoma. MATERIALS AND METHODS Loading efficacy of idarubicin with ONCOZENE DEE agents 100 µm and DC Bead (Biocompatibles UK Ltd, Farnham, United Kingdom) DEE agents 100-300 µm was monitored at 10, 20, and 30 minutes loading time by high-pressure liquid chromatography. A T-apparatus was used to monitor the release of idarubicin from the two types of DEE agents over 12 hours. Clinical and 24-hour pharmacokinetics data were recorded after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in four patients with unresectable hepatocellular carcinoma. RESULTS Idarubicin loading in ONCOZENE DEE agents was > 99% at 10 minutes. Time to reach 75% of the release plateau level was 37 minutes ± 6 for DC Bead DEE agents and 170 minutes ± 19 for ONCOZENE DEE agents both loaded with idarubicin 10 mg/mL. After transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents, three partial responses and one complete response were observed with only two asymptomatic grade 3 biologic adverse events. Median time to maximum concentration for idarubicin in patients was 10 minutes, and mean maximum concentration was 4.9 µg/L ± 1.7. Mean area under the concentration-time curve from 0-24 hours was equal to 29.5 µg.h/L ± 20.5. CONCLUSIONS ONCOZENE DEE agents show promising results with very fast loading ability, a favorable in vivo pharmacokinetics profile with a sustained release of idarubicin during the first 24 hours, and encouraging safety and responses. Histopathologic and clinical studies are needed to evaluate idarubicin release around the DEE agents in tumor tissue and to confirm safety and efficacy.
Collapse
Affiliation(s)
- Boris Guiu
- Department of Radiology, Saint-Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France.
| | - Antonin Schmitt
- Department of Pharmacy, Georges-François Leclerc Anticancer Center, Dijon, France
| | | | - Audrey Fohlen
- Department of Radiology, University Hospital, Caen, France
| | | | - Maëva Wendremaire
- Department of Pharmacology-Toxicology, University Hospital, Dijon, France
| | - Alban Denys
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mathieu Boulin
- Department of Pharmacy, University Hospital, Dijon, France
| |
Collapse
|
25
|
Li J, Zhang F, Yang J, Zhang Y, Wang Y, Fan W, Huang Y, Wang W, Ran H, Ke S. Combination of individualized local control and target-specific agent to improve unresectable liver cancer managements: a matched case-control study. Target Oncol 2014; 10:287-95. [PMID: 25293575 DOI: 10.1007/s11523-014-0338-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/18/2014] [Indexed: 01/17/2023]
Abstract
Management of late-stage hepatocellular carcinoma is difficult. A direct comparison of clinical data is needed in order to demonstrate the survival benefits of different therapies. We directly compared various therapies in a retrospective matched case-control study. A total of 79 patients with unresectable tumors greater than 10 cm in size were included in the study between 2008 and 2012. Thirty-five patients were treated with transarterial chemoembolization for local control, 20 were treated with sorafenib systemic chemotherapy, and 24 received combination treatment. The total follow-up time after initial therapy was 4.5 years. Survival time after treatment was significantly longer in the combination therapy group (P < 0.0001). The median survival times for combination, local control, and systemic chemotherapy were 15 (12-21), 10 (9-13), and 3.5 (2.5-9.0) months (95 % confidence interval), respectively. The hazard ratios for local control and systemic chemotherapy were 1.985 and 5.102, respectively, with combination treatment as the reference. There was no observed difference in combination therapy from the side effects of the individual therapies. In conclusion, the limited availability of therapeutic options for late-stage liver cancer necessitates reliance on multidisciplinary personalized medicine approaches with target-specific medications to increase survival time. Combining individualized local control therapy and drugs that target specific disease markers provides more benefits to patients.
Collapse
Affiliation(s)
- Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Boulin M, Hillon P, Cercueil JP, Bonnetain F, Dabakuyo S, Minello A, Jouve JL, Lepage C, Bardou M, Wendremaire M, Guerard P, Denys A, Grandvuillemin A, Chauffert B, Bedenne L, Guiu B. Idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma: results of the IDASPHERE phase I trial. Aliment Pharmacol Ther 2014; 39:1301-13. [PMID: 24738629 DOI: 10.1111/apt.12746] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/23/2013] [Accepted: 03/20/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND A phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads was performed in cirrhotic patients with hepatocellular carcinoma (HCC). AIM To estimate the maximum-tolerated dose (MTD) and to assess safety, efficacy, pharmacokinetics and quality of life. METHODS Patients received a single TACE session with injection of 2 mL drug-eluting beads (DEBs; DC Bead 300-500 μm) loaded with idarubicin. The idarubicin dose was escalated according to a modified continuous reassessment method. MTD was defined as the dose level closest to that causing dose-limiting toxicity (DLT) in 20% of patients. RESULTS Twenty-one patients were enrolled, including nine patients at 5 mg, six patients at 10 mg, and six patients at 15 mg. One patient at each dose level experienced DLT (acute myocardial infarction, hyperbilirubinaemia and elevated aspartate aminotransferase (AST) at 5-, 10- and 15-mg, respectively). The calculated MTD of idarubicin was 10 mg. The most frequent grade ≥3 adverse events were pain, elevated AST, elevated γ-glutamyltranspeptidase and thrombocytopenia. At 2 months, the objective response rate was 52% (complete response, 28%, and partial response, 24%) by modified Response Evaluation Criteria in Solid Tumours. The median time to progression was 12.1 months (95% CI 7.4 months--not reached); the median overall survival was 24.5 months (95% CI 14.7 months--not reached). Pharmacokinetic analysis demonstrated the ability of DEBs to release idarubicin slowly. CONCLUSIONS Using drug-eluting beads, the maximum-tolerated dose of idarubicin was 10 mg per TACE session. Encouraging responses and median time to progression were observed. Further clinical investigations are warranted (NCT01040559).
Collapse
Affiliation(s)
- M Boulin
- INSERM U866, University of Burgundy, Dijon, France; Department of Pharmacy, University Hospital, Dijon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Vogl TJ, Lee C. Doxorubicin -eluting beads in the treatment of liver carcinoma. Expert Opin Pharmacother 2013; 15:115-20. [PMID: 24215628 DOI: 10.1517/14656566.2014.855719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Doxorubicin and especially doxorubicin-eluting beads (DEBs) have become an intensive study subject in the locoregional therapy of liver carcinoma over the past 6 years. Since sorafenib has become the new standard in the treatment of advanced liver carcinoma and has been combined with DEB in clinical studies to evaluate safety and efficacy, it has shown promising results. Thus, the authors have investigated the evidence that DEB is a potential drug in the treatment of intermediate liver carcinoma, even in combination with systemic therapies. AREAS COVERED Evaluation of published articles in English using metadatabase such as PubMed. EXPERT OPINION Since there is no standard therapy regimen in the locoregional transarterial treatment of intermediate liver carcinoma, DEBs were designed to offer an attempt to homogenize the use of cytostatic and embolic agents. The development of so-called doxorubicin-eluting beads in the past few years is an effort to minimize systemic toxicity and increase local drug concentration. In the therapy of liver carcinoma, doxorubicin should not be systemically administered due to its high toxicity. Clinical trials indicate that the administration of DEB is safe and effective for the treatment of liver carcinoma and can even be combined with systemic drugs such as sorafenib.
Collapse
Affiliation(s)
- Thomas J Vogl
- J.W Goethe-University Hospital, Department of Diagnostic and Interventional Radiology , Theodor-Stern-Kai 7, 60590 Frankfurt/Main , Germany +0049 69 6301 7277 ; +0049 69 6301 7258 ;
| | | |
Collapse
|
28
|
Shindoh J, Kaseb A, Vauthey JN. Surgical strategy for liver cancers in the era of effective chemotherapy. Liver Cancer 2013; 2:47-54. [PMID: 24159596 PMCID: PMC3747536 DOI: 10.1159/000346222] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Systemic chemotherapy is the only option for advanced and/or disseminated disease in patients with hepatocellular carcinoma (HCC). For decades, various systemic therapies have been explored for the treatment of advanced HCC. Nevertheless, no satisfactory results have been obtained in cytotoxic chemotherapy so far. However, with the recent introduction of effective chemotherapy agents including sorafenib, the role of systemic therapy for the treatment of HCC is changing. The goals of systemic therapy include prolongation of survival with stabilization of disease progression and, in selected patients, downsizing of primarily unresectable tumors. In the era of effective chemotherapy, patients with advanced HCC should be managed with individualized approaches to optimize outcome.
Collapse
Affiliation(s)
- Junichi Shindoh
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex., USA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex., USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex., USA,*Jean-Nicolas Vauthey, MD, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Boulevard, Unit 1484, Houston, TX 77030 (USA), E-Mail
| |
Collapse
|
29
|
Kim BH, Park JW. Recent advances in systemic chemotherapy of hepatocellular carcinoma. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.11.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Bo Hyun Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Joong-Won Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| |
Collapse
|
30
|
Asghar U, Meyer T. Are there opportunities for chemotherapy in the treatment of hepatocellular cancer? J Hepatol 2012; 56:686-95. [PMID: 21971559 DOI: 10.1016/j.jhep.2011.07.031] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 07/25/2011] [Accepted: 07/28/2011] [Indexed: 02/07/2023]
Abstract
Hepatocellular cancer is a significant global health problem yet the prognosis for the majority of patients has not changed significantly over the past few decades. For patients with advanced disease, sorafenib is currently the standard of care providing a survival advantage of 2-3 months in selected patients. Cytotoxic chemotherapy has been used for over 30 years but definite evidence that it prolongs survival has been lacking. Resistance remains a significant barrier for both targeted and cytotoxic agents and an understanding of the underlying mechanisms is critical if outcomes are to be improved. Here, we summarise the past and current data that constitute the evidence base for chemotherapy in HCC, review the causes of chemoresistance and suggest strategies to overcome these barriers.
Collapse
Affiliation(s)
- Uzma Asghar
- Department of Oncology, UCL Medical School, Royal Free Campus, London, UK
| | | |
Collapse
|
31
|
Walusansa V, Okuku F, Orem J. Burkitt lymphoma in UGANDA, the legacy of Denis Burkitt and an update on the disease status. Br J Haematol 2012; 156:757-60. [DOI: 10.1111/j.1365-2141.2012.09027.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/24/2011] [Indexed: 11/30/2022]
Affiliation(s)
| | - Fred Okuku
- Uganda Cancer Institute; Kampala; Uganda
| | | |
Collapse
|
32
|
Shrimal A, Prasanth M, Kulkarni AV. Interventional radiological treatment of hepatocellular carcinoma: an update. Indian J Surg 2012; 74:91-9. [PMID: 23372313 PMCID: PMC3259173 DOI: 10.1007/s12262-011-0377-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/10/2011] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma is the commonest primary liver tumor and its incidence is on an increase.Transplantation and surgical resection are the gold standard curative treatment options but less than 20%patients are surgical candidates because of advanced liver disease and/or co-morbidities.Various interventional radiological procedures have been developed and intensively investigated for treatment of inoperable HCC.This review summarizes the various interventional radiological treatments in HCC including patient selection, procedural considerations and response evaluation. Transarterial chemoembolization, radioembolization and radiofrequency ablation are mainly discussed.
Collapse
Affiliation(s)
- Anurag Shrimal
- Department of Surgery and Radiology, P D Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mumbai, 400016 India
| | - Madhu Prasanth
- Department of Surgery and Radiology, P D Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mumbai, 400016 India
| | - A. V. Kulkarni
- Department of Surgery and Radiology, P D Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mumbai, 400016 India
| |
Collapse
|
33
|
Chang JE, Shim WS, Yang SG, Kwak EY, Chong S, Kim DD, Chung SJ, Shim CK. Liver cancer targeting of Doxorubicin with reduced distribution to the heart using hematoporphyrin-modified albumin nanoparticles in rats. Pharm Res 2011; 29:795-805. [PMID: 21971829 DOI: 10.1007/s11095-011-0603-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 09/21/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the usefulness of hematoporphyrin (HP)-modification of the surface of doxorubicin (DOX)-loaded bovine serum albumin (BSA) nanoparticles (NPs) in the liver cancer-selective delivery of DOX. METHODS HP-modified NPs (HP-NPs) were prepared by conjugation of amino groups on the surface of NPs with HP, a ligand for low density lipoprotein (LDL) receptors on the hepatoma cells. In vitro cellular accumulation of DOX, in vivo biodistribution of DOX, safety, and anti-tumor efficacy were evaluated for HP-NPs. RESULTS Cytotoxicity and accumulation of DOX were in the order of HP-NPs>NPs>solution form (SOL). Cellular uptake from HP-NPs was proportional to the expression level of LDL receptors on the cells, indicating possible involvement of LDL receptor-mediated endocytosis (RME) in uptake. The "merit index," an AUC ratio of DOX in liver (target organ) to DOX in heart (major side effect organ) following iv administration of HP-NPs to hepatoma rats, was 132.5 and 4 times greater compared to SOL and NPs, respectively. The greatest suppression of body weight decrease and tumor size increase was observed for iv-administered HP-NPs in tumor-bearing mice. CONCLUSIONS HP modification appears to be useful in selective delivery of NP-loaded DOX to tumors.
Collapse
Affiliation(s)
- Ji-Eun Chang
- National Research Laboratory for Transporters Targeted Drug Design Research Institute of Pharmaceutical Sciences College of Pharmacy, Seoul National University, Seoul, 151-742, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Ocama P, Opio KC, Kagimu M, Seremba E, Wabinga H, Colebunders R. Hepatitis B virus and HIV infection among patients with primary hepatocellular carcinoma in Kampala, Uganda. Afr Health Sci 2011; 11 Suppl 1:S20-3. [PMID: 22135639 DOI: 10.4314/ahs.v11i3.70065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) is the commonest cause of primary hepatocellular (PHC) carcinoma worldwide. Co-infection with the HIV leads to more rapid progression of liver disease. OBJECTIVES We described prevalence of HBV and HIV among patients with PHC admitted to Mulago Hospital, Kampala, Uganda. METHODS We assessed all patients admitted to the gastrointestinal service of Mulago hospital with a diagnosis of PHC for HBV and HIV infection. RESULTS From March to June 2008, we recruited 15 patients. Nine (60%) were male; the overall median age was 32 years (IQR 15 -67), with median ages for male and female 33 and 36 years respectively. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and AFP were all elevated with median values of 57.5 IU/L, 222 IU/L, 392 IU/L and 362 ng/ml respectively (IQR 14-145, 49-393, 165-1294 and 7-480). Eight (53%) patients were from North and Northeastern Uganda. The HBsAg was reactive in 13(87%) patients and HIV in 3(20%), all of whom were also co-infected with HBV. CONCLUSION There is high prevalence of HBV and HBV/HIV co-infection among patients with PHC in Uganda with high mortality. Reduction in incidence and mortality due to PHC in Uganda will require urgent large scale HBV vaccination.
Collapse
Affiliation(s)
- P Ocama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | | | | | | | | | | |
Collapse
|
36
|
Wrzesinski SH, Taddei TH, Strazzabosco M. Systemic therapy in hepatocellular carcinoma. Clin Liver Dis 2011; 15:423-41, vii-x. [PMID: 21689622 PMCID: PMC3758582 DOI: 10.1016/j.cld.2011.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Many potential systemic therapies are being investigated for the treatment of hepatocellular carcinoma (HCC). The incidence of this malignancy is rising sharply and the vast majority of patients present at advanced stages. Although the earlier dismal results with cytotoxic chemotherapies made way for the development of locoregional therapies that provided improved overall survival, truly personalized therapy will require the selection of phenotypically similar stages of disease and populations, an understanding of the complex molecular and genetic pathways leading to HCC, and a keen understanding of the pathobiology of cirrhosis. Only then will we understand how to offer a particular patient at a specific stage of disease the appropriate therapy to truly prolong survival.
Collapse
Affiliation(s)
- Stephen H. Wrzesinski
- Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA,VA Connecticut Healthcare System, Comprehensive Cancer Center, 950 Campbell Avenue–111D, West Haven, CT 06516–2700, USA
| | - Tamar H. Taddei
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street/1080 LMP, PO Box 208019, New Haven, CT 06520–8019, USA,VA Connecticut Healthcare System, Hepatitis C Resource Center (HCRC), 950 Campbell Avenue-111H, West Haven, CT 06516-2700, USA
| | - Mario Strazzabosco
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street/1080 LMP, PO Box 208019, New Haven, CT 06520–8019, USA,Yale Liver Center, Department of Internal Medicine, Yale University, Cedar Street 333, New Haven, CT 06520, USA,Section of Digestive Diseases, University of Milan-Bicocca, Monza, Italy,Corresponding author. Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street/1080 LMP, PO Box 208019, New Haven, CT 06520-8019.
| |
Collapse
|
37
|
Abstract
BACKGROUND Locoregional treatments of hepatocellular carcinoma (HCC) have evolved over the past 20 years. Interventional radiologists have developed an important role in the palliative and curative treatment of the disease. This review summarizes commonly used interventional radiological treatment protocols to assist practitioners in understanding the techniques used to treat HCC. METHODS Various searches were performed to evaluate recent publications regarding systemic treatments of HCC as well as transplant/surgery, chemoembolization, yttrium-90 radioembolization, percutaneous radiofrequency ablation (RFA), cryoablation, and percutaneous ethanol injection (PEI). RESULTS No standard for chemoembolization was found. Two studies evaluating survival with chemoembolization vs medical therapy found benefits with the former. PEI offers favorable outcomes in small HCC but has increased recurrence and decreased long-term survival compared with RFA. Local recurrence, response rates, and mortality from RFA rival surgical resection in HCC less than 3 cm. Cryoablation appears to be effective, and yttrium-90 radioembolization is an additional tool. CONCLUSIONS Chemoembolization improves survival and offers improved tumor response compared to systemic treatment. More studies are needed to standardize chemoembolization preparations and techniques. RFA provides better results than PEI but has not been compared with cryoablation. Radioembolization appears to be as effective as chemoembolization, but the preprocedure evaluation and costs may limit its use.
Collapse
Affiliation(s)
- Cliff R Davis
- Tampa General Hospital, Radiology Association of Tampa/Department of Interventional Radiology, Tampa, FL 33606, USA.
| |
Collapse
|
38
|
Giglia JL, Antonia SJ, Berk LB, Bruno S, Dessureault S, Finkelstein SE. Systemic therapy for advanced hepatocellular carcinoma: past, present, and future. Cancer Control 2010; 17:120-9. [PMID: 20404795 DOI: 10.1177/107327481001700207] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although approximately 80% of hepatocellular carcinoma (HCC) cases occur in developing countries, the incidence of HCC in Western countries is on the rise due to the impact of hepatitis C. Challenges in developing effective therapies include the inherent chemoresistance of HCC, the pharmacologic challenges presented by a diseased liver, the presentation of most patients at advanced stages, and the difficulty in adequately measuring radiological response. While responses to traditional chemotherapeutic agents have been documented, significant survival benefit is debatable. METHODS The authors review the results of published clinical trials of systemic therapy and immunotherapy that have impacted the present treatment of HCC. RESULTS With recent progress in the elucidation of HCC molecular pathways, targeted agents show promise. The multikinase inhibitor sorafenib has provided survival benefit in patients with advanced HCC and well-preserved liver function. Sunitinib, bevacizumab, epidermal growth factor receptor inhibitors, and mammalian target of rapamycin (mTOR) inhibitors have shown activity in small patient cohorts. Immunotherapy appears to be a promising approach that can result in the regression of bulky, invasive cancer in some patients. CONCLUSIONS New agents with a variety of mechanisms of activity offer promising therapeutic options for patients with advanced HCC.
Collapse
Affiliation(s)
- Jennifer L Giglia
- Gastrointestinal Tumor Program, Moffitt Cancer Center, Tampa, FL 33612, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Alterations of cellular organelles in human liver-derived hepatoma G2 cells induced by adriamycin. Anticancer Drugs 2009; 20:779-86. [PMID: 19617817 DOI: 10.1097/cad.0b013e32832f4e6f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adriamycin (ADM) is a commonly used chemotherapeutic drug in the treatment of hepatocellular carcinoma. However, the mechanisms involved in ADM-induced cell death and the molecular basis of ADM resistance are still unclear. To observe the early events that occurred in hepatoma cells in response to ADM, we investigated the alterations of morphology and subcellular distributions of cellular organelles in human liver-derived hepatoma G2 (HepG2) cells after ADM treatment. HepG2 cells were exposed to different doses of ADM for up to 60 h. Cytotoxicity occurred 24 h after 0.05 microg/ml ADM application, and remaining living cells showed irregular shapes but continued to multiply. Some cellular organelles altered their subcellular distribution or morphology after ADM treatment, including mitochondria, autophagic vacuoles, and Golgi apparatus. Immunoblotting with anti-LC3 antibody showed the upregulation of LC3-II protein, confirming that ADM leads to the induction of autophagy in HepG2 cells. Our findings suggest that among most of the cellular organelles, mitochondria and autophagic vacuoles were involved in the early ADM response, and may contribute to ADM-induced HepG2 cell death.
Collapse
|
40
|
Bekaii-Saab T, Markowitz J, Prescott N, Sadee W, Heerema N, Wei L, Dai Z, Papp A, Campbell A, Culler K, Balint C, O'Neil B, Lee RM, Zalupski M, Dancey J, Chen H, Grever M, Eng C, Villalona-Calero M. A multi-institutional phase II study of the efficacy and tolerability of lapatinib in patients with advanced hepatocellular carcinomas. Clin Cancer Res 2009; 15:5895-901. [PMID: 19737952 PMCID: PMC2774354 DOI: 10.1158/1078-0432.ccr-09-0465] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is on the rise worldwide. HCC responds poorly to chemotherapy. Lapatinib is an inhibitor of epidermal growth factor receptor and HER2/NEU both implicated in hepatocarcinogenesis. This trial was designed to determine the safety and efficacy of lapatinib in HCC. METHODS A Fleming phase II design with a single stage of 25 patients with a 90% power to exclude a true response rate of <10% and detect a true response rate of > or =30% was used. The dose of lapatinib was 1,500 mg/day administered orally in 28-day cycles. Tumor and blood specimens were analyzed for expression of HER2/NEU/CEP17 and status of downstream signal pathway proteins. RESULTS Twenty-six patients with HCC enrolled on this study. Nineteen percent had one prior therapy. Most common toxicities were diarrhea (73%), nausea (54%), and rash (42%). No objective responses were observed. Ten (40%) patients had stable disease as their best response including six (23%) with stable disease lasting >120 days. Median progression-free survival was 1.9 months and median overall survival was 12.6 months. Patients who developed a rash had a borderline statistically significant longer survival. Tissue and blood specimens were available on >90% of patients. No somatic mutations in EGFR (exons 18-21) were found. In contrast to our previous findings, we did not find evidence of HER2/NEU somatic mutations. PTEN, P-AKT, and P70S6K expression did not correlate with survival. CONCLUSIONS Lapatinib is well-tolerated but seems to benefit only a subgroup of patients for whom predictive molecular or clinical characteristics are not yet fully defined.
Collapse
Affiliation(s)
- Tanios Bekaii-Saab
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kasai K, Kuroda H, Ushio A, Sawara K, Takikawa Y, Suzuki K. Evaluation of newly developed combination therapy of intra-arterial 5-fluorouracil and systemic pegylated interferon alpha-2b for advanced hepatocellular carcinoma with portal venous invasion: preliminary results. Hepatol Res 2009; 39:117-25. [PMID: 19208032 DOI: 10.1111/j.1872-034x.2008.00414.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM Prognosis is extremely poor for advanced hepatocellular carcinoma (HCC) in patients with portal invasion. The present study evaluated the efficacy of combined intra-arterial 5-fluorouracil (5-FU) and systemic pegylated interferon (PEG-IFN)alpha-2b in patients with advanced HCC. METHODS The subjects comprised nine HCC patients with portal vein thrombosis treated using subcutaneous administration of PEG-IFNalpha-2b (50-100 microg on day 1 of every week, for 4 weeks) and intra-arterial infusion of 5-FU (250 mg/day for 5 h on days 1-5 of every week, for 4 weeks). For four patients with hepatitis C virus (HCV) infection, oral administration of ribavirin (400-800 mg/day) was added. At the end of every cycle, response to therapy was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. RESULTS Partial response (PR) was observed in seven of nine patients, with stable or progressive disease in the remaining two patients. Tumors were resectable in three patients displaying PR after treatment. Tumor markers decreased significantly after therapy. Serum HCV-RNA titers were markedly decreased and became undetectable in all patients with HCV infection. National Cancer Institute-Common Toxicity Criteria: version 3.0 (NCI-CTC) grade 3 thrombocytopenia was seen in one case at the end of treatment, but was resolved with cessation of treatment. Other adverse effects were manageable. CONCLUSION Combination therapy with intra-arterial 5-FU and systemic PEG-IFNalpha-2b may be useful as a palliative treatment for patients with advanced HCC. A prospective controlled trial using a larger population of patients with advanced HCC is needed to evaluate this new combination therapy.
Collapse
Affiliation(s)
- Kazuhiro Kasai
- Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Iwate, Japan
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, causing 500,000 deaths yearly. The risk factors mostly responsible for the rising incidence of HCC in the Western hemisphere are hepatitis C, alcoholic cirrhosis, and nonalcoholic steatohepatitis, which most commonly leads to HCC in the setting of cirrhosis. Over the past 30 years, several chemotherapeutic single agents and combinations have been tested in HCC, yet none have demonstrated any improvement in survival. Recently, the multitargeted anti-angiogenic and Raf kinase inhibitor sorafenib has shown a survival advantage as a single agent and improved outcomes in combination with doxorubicin. Other novel agents have also shown intriguing outcomes as single agents (sunitinib) or in combination (bevacizumab and erlotinib). The encouraging results and clinical information gathered in recent trials are generating important clinical questions regarding which patients to treat, how to accommodate concurrent cirrhosis, and which parameters to use to monitor efficacy and the potential benefit from therapy.
Collapse
|
43
|
Kim RD, Reed AI, Fujita S, Foley DP, Mekeel KL, Hemming AW. Consensus and controversy in the management of hepatocellular carcinoma. J Am Coll Surg 2007; 205:108-23. [PMID: 17617340 DOI: 10.1016/j.jamcollsurg.2007.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 01/24/2007] [Accepted: 02/06/2007] [Indexed: 12/20/2022]
Affiliation(s)
- Robin D Kim
- Division of Transplantation and Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Florida School of Medicine, Gainesville, FL 32610-0286, USA
| | | | | | | | | | | |
Collapse
|
44
|
Chuu JJ, Liu JM, Tsou MH, Huang CL, Chen CP, Wang HS, Chen CT. Effects of paclitaxel and doxorubicin in histocultures of hepatocelular
carcinomas. J Biomed Sci 2007; 14:233-44. [PMID: 17206490 DOI: 10.1007/s11373-006-9141-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 12/06/2006] [Indexed: 01/12/2023] Open
Abstract
Cancer has been the leading cause of death in Taiwan over the past two decades and liver cancer is the leading cause of all cancer deaths in Taiwan with a trend of increase in incidence. Therapeutic options and efficacy for liver cancer have been limited and the 5-year survival rate is less than 7% in the Unite States. The study was conducted to establish a histoculture system of human hepatocellular carcinomas (HCC) for biological and pharmacological studies and to determine the efficacy of anticancer drugs with the established HCC histocultures. Patient HCC tissues freshly obtained after surgeries were prepared and histocultured. The histocultured HCC were treated with doxorubicin and paclitaxel of various concentrations for 96-h. Upon drug treatments, the activity of tumor cell proliferation and extent of cell death induction were measured and changes of the alpha-fetoprotein levels in the culture medium were determined. We demonstrated that human HCC can be successfully cultured in a 3-dimensional histoculture system and used for pharmacological studies. Doxorubicin and paclitaxel showed concentration-dependent activities in anti-proliferation and cell death induction against the human HCC. Inhibitory effects of both drugs on alpha-fetoprotein production of the cultured HCC were in agreement with their anti-proliferative effects. Exposure time-dependent antitumoral effects of paclitaxel treatments at 3-, 24-, and 96-h against the histocultured HCC PLC/PRF/5 xenograft tumors were also observed. In conclusion, we have demonstrated a histoculture system for patient HCC and it can be utilized in selection of active drugs prior to treatments in patients and in evaluation of new agents against HCC, for which therapeutic agents are in desperate needs worldwide.
Collapse
Affiliation(s)
- Jiunn-Jye Chuu
- Division of Biotechnology and Pharmaceutical Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli, 35053, Taiwan
| | | | | | | | | | | | | |
Collapse
|
45
|
Almhanna K, Kim R, Kalmadi S. Treatment Approaches for Hepatocellular Carcinoma. Clin Med Oncol 2007. [DOI: 10.1177/117955490700100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, and it is responsible for up to one million deaths annually. Although multiple risk factors for HCC have been identified, and despite preventive measures, the incidence of HCC continues to rise to epidemiologic proportions in the United States. In general, tumor resection and orthotopic liver transplantation are the treatment with the best outcome; however, HCC is generally diagnosed late in its course when patients are not eligible for curative treatment options. HCC is a relatively Chemo-refractory tumor secondary to heterogeneity of the tumor and the high rate of multidrug resistant gene expression. There are no standard treatments for HCC, multiple palliative treatment modalities have been used for patients with unresectable disease. None of these modalities have shown any superiority; and the retrospective nature of these available data has confounded any reasonable conclusions. Different institutions use different treatment schema dependent on the center expertise. Sorafenib, a tyrosine kinase inhibitor, has recently demonstrated a survival advantage in metastatic HCC, and if approved by the FDA, might become the standard of care. In this article we will review the rationale behind the currently available treatment options for HCC.
Collapse
Affiliation(s)
- Khaldoun Almhanna
- Gastrointestinal Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Kim
- Gastrointestinal Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Sujith Kalmadi
- Gastrointestinal Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
46
|
Hebbar M, Ernst O, Cattan S, Dominguez S, Oprea C, Mathurin P, Triboulet JP, Paris JC, Pruvot FR. Phase II Trial of Docetaxel Therapy in Patients with Advanced Hepatocellular Carcinoma. Oncology 2006; 70:154-8. [PMID: 16645329 DOI: 10.1159/000093007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 02/25/2006] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We assessed the safety and efficacy of docetaxel, a microtubule inhibitor, in patients with advanced hepatocellular carcinoma (HCC). METHODS HCC patients that were not suitable for local therapy, but who possessed measurable disease, good performance status and adequate organ function were eligible. Docetaxel was administered every 3 weeks at a dose of 100 mg/m(2) (or 75 mg/m(2) if transaminase levels were between 1.5 and 3.5 times the upper normal limit). Efficacy was assessed radiologically every three cycles of chemotherapy. RESULTS Fifteen patients were enrolled: 11 males and 4 females; their median age was 64 years (range, 42-72 years). Nine patients had underlying cirrhosis. Four patients had been surgically treated before relapse (liver resection in 3 cases and transplantation in 1), 3 had been treated with arterial chemoembolization and 1 with arterial chemotherapy (doxorubicin). A total of 57 cycles of docetaxel were delivered (median 3, range 1-6). Significant toxicity was observed: mostly grade 3-4 neutropenia and fatigue (6 and 4 patients, respectively). Treatment had to be stopped because of toxicity in 6 patients, all having underlying cirrhosis. An important partial response was obtained in 1 patient, a result that enabled liver transplantation; this patient is still alive after 34 months. Five patients had transient stable disease. CONCLUSION When used in this schedule, docetaxel does not appear to be safe and effective enough in patients with advanced HCC and cirrhosis.
Collapse
Affiliation(s)
- Mohamed Hebbar
- Unité d'Oncologie Médicale, Centre Hospitalo-Universitaire, Lille, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kim SJ, Seo HY, Choi JG, Sul HR, Sung HJ, Park KH, Choi IK, Oh SC, Yoon SY, Seo JH, Choi CW, Kim BS, Shin SW, Kim YH, Kim JS. Phase II study with a combination of epirubicin, cisplatin, UFT, and leucovorin in advanced hepatocellular carcinoma. Cancer Chemother Pharmacol 2005; 57:436-42. [PMID: 16049620 DOI: 10.1007/s00280-005-0067-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 06/14/2005] [Indexed: 01/25/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Because HCC usually presents as an advanced disease and occurs in the background of liver cirrhosis, most patients are not suitable for treatment with curative intent, thus effective systemic chemotherapy is required. However, the outcome of systemic chemotherapy has been disappointing in advanced HCC. This study was conducted to test the efficacy and toxicity of the combined regimen of epirubicin, cisplatin, and UFT moderated by leucovorin in advanced or recurrent HCC. PATIENTS AND METHODS All 53 patients received epirubicin (50 mg/m2 i.v.) on day 1 and cisplatin (60 mg/m2 i.v.) after epirubicin administration. Oral UFT 400-600 mg/day, determined by body surface area, and leucovorin 75 mg/day were administered for 21 consecutive days, followed by a 7-day drug free interval. RESULTS Nine had a partial response, representing 16.9% of response rate (95% confidence interval rate; 7.0-26.8%) with median response duration of 17.1 weeks (95% CI; 5.0-29.3 weeks, range; 7.1-51.7 weeks). Fifteen patients had stable disease and the disease progressed in 26 patients. The median overall survival for the patients was 24.6 weeks (95% CI; 17.3-31.9 weeks, range; 3.0-131.3 weeks). The main toxicities were hematologic toxicities including neutropenia, which reached grade 3/4 in 17 patients (38.5%), and grade 3 or 4 thrombocytopenia in five patients (9.4%). CONCLUSION The combination of epirubicin, cisplatin, and UFT moderated by leucovorin showed modest anti-tumor activity with relatively tolerable toxicities. However, a randomized phase III trial based on this regimen is warranted to clarify its survival benefit in patients with advanced HCC.
Collapse
Affiliation(s)
- Seok Jin Kim
- Division of Hematology/Oncology Department of Internal Medicine, Korea University Medical Center, 126-1, Anam-dong 5-ga, Sungbuk-ku, Seoul, 136-705, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Nowak AK, Chow PKH, Findlay M. Systemic therapy for advanced hepatocellular carcinoma: a review. Eur J Cancer 2004; 40:1474-84. [PMID: 15196530 DOI: 10.1016/j.ejca.2004.02.027] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 02/13/2004] [Indexed: 12/19/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common cause of cancer mortality worldwide. Whilst local treatments are useful in selected patients, they are not suitable for many with advanced disease. Here, we review phase II and III trials for systemic therapy of advanced disease, finding no strong evidence that any chemotherapy, hormonal therapy, or immunotherapy regimen trialled to date benefits survival in this setting. Many trials were inadequately powered, single centre, and enrolled highly selected patients. From this review, we cannot recommend any therapeutic approach in these patients outside of a clinical trial setting. Including an untreated control arm in clinical trials in HCC is still justified. Every effort should be made to enroll these patients into adequately powered trials, and promising phase II results must be tested in a multicentre phase III setting, preferably against a placebo control arm. Prevention of hepatitis B and C remains vital to decrease deaths from HCC.
Collapse
Affiliation(s)
- Anna K Nowak
- NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77 Camperdown, NSW 1450, Australia.
| | | | | |
Collapse
|
49
|
Burroughs A, Hochhauser D, Meyer T. Systemic treatment and liver transplantation for hepatocellular carcinoma: two ends of the therapeutic spectrum. Lancet Oncol 2004; 5:409-18. [PMID: 15231247 DOI: 10.1016/s1470-2045(04)01508-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma is the fifth most common malignant disorder and causes nearly 1 million deaths a year worldwide. A background of cirrhosis is the major risk factor, and in Asia and subSaharan Africa, cirrhosis is attributable mainly to endemic hepatitis B infection. In Europe and the USA the incidence of hepatocellular carcinoma is increasing as a result of the high prevalence of hepatitis C. The only curative treatments are surgical resection or liver transplantation, but only a few patients are eligible for these procedures. Local ablative treatments such as ethanol injection can lengthen survival in selected patients, and radiofrequency ablation also shows promise. Unfortunately, most patients are suitable only for palliative treatment because of the extent of their tumour or background liver disease or both. For these patients, a wide range of therapeutic interventions have been assessed, including transarterial embolisation (with or without chemotherapy), hormone therapy with antioestrogens and androgens, octreotide, interferon, and both arterial and systemic chemotherapy, of which only chemoembolisation improves survival over symptomatic care. Tamoxifen is ineffective, and there are insufficient randomised data to show the benefit of any other intervention. In this review, we focus on two ends of the therapeutic spectrum--transplantation, which is highly effective but applicable to only a few patients, and systemic chemotherapy, which is of uncertain benefit but widely applicable.
Collapse
Affiliation(s)
- Andrew Burroughs
- Liver Transplantation and Hepatobiliary Medicine Department, Royal Free and University College Medical School, London, UK
| | | | | |
Collapse
|
50
|
Feun LG, O'Brien C, Molina E, Rodriguez M, Jeffers L, Schiff ER, Marini A, Savaraj N, Ardalan B. Recombinant leukocyte interferon, doxorubicin, and 5FUDR in patients with hepatocellular carcinoma-A phase II trial. J Cancer Res Clin Oncol 2003; 129:17-20. [PMID: 12618896 DOI: 10.1007/s00432-002-0398-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2002] [Accepted: 10/29/2002] [Indexed: 01/26/2023]
Abstract
PURPOSE To study the combination of 5FUDR, recombinant leukocyte interferon (IFN), and doxorubicin in patients with unresectable hepatocellular carcinoma. METHODS IFN was administered at a dose of 6 miu/m(2) subcutaneously followed in 2 h by doxorubicin 20 mg/m(2) intravenously. After doxorubicin, 5FUDR was given as a 24-h infusion at a starting dose of 80 mg/kg. The dose of IFN was escalated to three times a week if tolerated. Both doxorubicin and 5FUDR were administered once weekly. RESULTS There were 30 patients entered into the study. Among the 30 patients, there were two partial responses (7%) and one patient had stable disease. Toxicity was generally tolerable with fever, and chills, fatigue, and myelosuppression as the most common side effects. CONCLUSIONS This chemotherapy combination was generally well tolerated, but has limited activity in unresectable, advanced hepatocellular carcinoma.
Collapse
Affiliation(s)
- Lynn G Feun
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Avenue, Miami, Florida, USA
| | | | | | | | | | | | | | | | | |
Collapse
|