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Thongprasert S, Qin S, Lim H, Bhudhisawasdi V, Yin X, Gang W, Kim B, Jian Z, Yang T, Rau K. Efficacy of oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX4) versus doxorubicin in advanced HCC: Updates on the EACH study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
160 Background: In Asia, where hepatitis B is very common, patients often present with locally advanced or metastatic hepatocellular carcinoma (HCC), and their prognosis is poor. The EACH study was designed to evaluate the efficacy and safety of FOLFOX4 vs. doxorubicin as palliative systemic chemotherapy in advanced HCC. Methods: The open-label, randomized, multicenter phase III study was conducted in 371 patients in China, Taiwan, Korea and Thailand, who had locally advanced or metastatic HCC and were ineligible for resection. Patients were randomized 1:1 to receive either FOLFOX4 (oxaliplatin 85 mg/m2 i.v. d1; LV 200 mg/m2 i.v. h0–h2 d1 and d2; 5FU 400 mg/m2 i.v. bolus h2, then 600 mg/m2 over 22 hours d1 and d2 q2w) or doxorubicin (50 mg/m2 i.v. q3w). The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), response rate (RR) by RECIST and safety. Data from final and follow-up analyses of the intent-to-treat (ITT) population and selected subgroup analyses are presented. Results: At the final analysis, median OS with FOLFOX4 (N = 184) was 6.40 months (95% CI: 5.30, 7.03) vs. 4.97 months (95% CI: 4.23, 6.03) with doxorubicin [N = 187; p = 0.0695 using a stratified log-rank test; statistical significance (p = 0.0425) was achieved at the post hoc follow-up analysis conducted 7 months later]. Median PFS with FOLFOX4 was 2.93 months (95% CI: 2.43, 3.53) vs. 1.77 months with doxorubicin (95% CI: 1.63, 2.30; p = 0.0002). The RR was 8.2% vs. 2.7% of patients with FOLFOX4 and doxorubicin, respectively (p = 0.0233), and the disease control rate (DCR) was 52.2% vs. 31.6% (p < 0.0001). In the Chinese sub-population, OS, PFS, RR and DCR were significantly improved with FOLFOX4 vs. doxorubicin at both the final and follow-up analyses. In the other subgroups analyzed, the OS and PFS benefits of FOLFOX4 vs. doxorubicin were generally consistent. Conclusions: In the ITT population, median OS was greater with FOLFOX4 than doxorubicin throughout the study and statistical significance was achieved after continued follow-up. FOLFOX4 can benefit patients with advanced HCC, as it significantly increases median OS, PFS, RR and DCR compared with doxorubicin. [Table: see text]
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Affiliation(s)
- S. Thongprasert
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - S. Qin
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - H. Lim
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - V. Bhudhisawasdi
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - X. Yin
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - W. Gang
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - B. Kim
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - Z. Jian
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - T. Yang
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
| | - K. Rau
- Chiang Mai University, Chiang Mai, Thailand; Nanjing Bayi Hospital, Nanjing, China; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Khon Kaen University, Khon Kaen, Thailand; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Wuhan Union Hospital, Wuhan, China; Seoul Bohun Hospital, Seoul, South Korea; Guangdong Provincial People's Hospital, Guangzhou, China; Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Chang Gung
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Abstract
Intrahepatic cholangiocarcinoma is defined as adenocarcinoma originating from bile ductules and segmental and lobar intrahepatic ducts. Four types of surgical pathology have been identified in the Khon Kaen endemic area in Thailand: peripheral, type I; intermediate, type II; central, type III; and diffuse, type IV. We report our experience with intrahepatic cholangiocarcinoma with emphasis on the surgical pathology, operative procedure, and associated survival time. We reviewed the records of patients treated for cholangiocarcinoma at Srinagarind Hospital from January 1, 1992 to February 28, 1997. There was a total of 411 patients, and 138 were intrahepatic and non-jaundiced. Tumors in the proximity of the gray zone i.e., portal, periportal with jaundice, were excluded. Patient profiles, surgical pathology, operative procedure, postoperative morbidity, and mortality were recorded. The data were analyzed using Kaplan-Meier survival curves. Of the 138 patients with intrahepatic disease who were non-jaundiced, 116 had type I, 10 had type II-III, and 12 had type IV. The wear ages of the patients were: 53.0, SE 9.2 years in type I; 57.1, SE 4.6 years in type II-III, and 50.2, SE 9.2 years in type IV. The male-to-female ratios in the three groups were 1.4 : 1, 1.5 : 1, and 5 : 1, respectively. The mean survival times in the three groups were 556, SE 63 days 374, SE 149 days and 97, SE 35 days. Most of the surgical procedures were tumor excisions (108/138). Right hepatectomy was performed in 63 patients, extended right hepatectomy in 8, left hepatectomy in 18, and extended left hepatectomy in 1. Palliative procedures were performed in the other patients because tumors were in both lobes. The mean survival time was 582 days (SE, 75), for right lobe surgery; 458 days (SE, 89) for left lobe surgery; and 127 days (SE, 58) for the other procedures. Mean survival time was 1039 days (SE, 201) in tumor stage III, 773 days (SE, 123) in stage IVa, and 382 days (SE, 60) in stage IVb. There were no significant differences in survival time according to age or sex. The results of surgery in type I and type II-III were better than the results in type IV. Survival time after right hepatectomy was better than that after left hepatectomy, although without statistical significance, but survival time was significantly better after both operations than after palliative procedures. The results of surgery according to pathological staging showed that survival time in stage III was better than that in either stage IVa or IVb, but only the difference from stage IVb was significant.
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Affiliation(s)
- T Uttaravichien
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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