Chapter 088. Hepatocellular Carcinoma (Part 8)

Table 88-5 Some Randomized Clinical Trials Involving Transhepatic Artery Chemoembolization (TACE) for Hepatocellular Carcinoma YeaAgents 1Agents 2Surviva l EffectKawaii1992Doxorubici n + emboEmboNoChang1994 emboCisplatin +EmboNoHatanaka1995Cisplatin, doxorubicin emboSame + ethiodol+NoUchino1993Cisplatin,Same+Nodoxorubicin + oral tamoxifen FULin1988Embo IV FUEmbo+NoYoshikaw a1994 +Epirubicin ethiodol nEpirubiciNo(Lipiodol)Pelletier1990Doxorubici n + GelfoamNoneNoTrinchet1995Cisplatin + GelfoamNoneNoBruix1998Coils GelfoamandNoneNoPelletier1998Cisplatin + ethiodolNoneNoTrinchet1995Cisplatin + GelfoamNoneNoPelletier1998Cisplatin + ethiodolNoneNoLo2002Cisplatin + ethiodolNoneYesLlovet2002Doxorubici n + ethiodolNoneYesNote: embo, embolization; FU, fluorouracil.Experimental...
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Chapter 088. Hepatocellular Carcinoma (Part 8) Chapter 088. Hepatocellular Carcinoma (Part 8) Table 88-5 Some Randomized Clinical Trials Involving TranshepaticArtery Chemoembolization (TACE) for Hepatocellular Carcinoma Author Yea Agents 1 Agents 2 Surviva r l Effect Kawaii 1992 Doxorubici Embo No n + embo Chang 1994 Cisplatin + Embo No embo Hatanaka 1995 Cisplatin, Same + No doxorubicin + ethiodol embo Uchino 1993 Cisplatin, Same + No doxorubicin + oral tamoxifen FU Lin 1988 Embo Embo + No IV FU Yoshikaw 1994 Epirubicin Epirubici Noa + ethiodol n (Lipiodol) Pelletier 1990 Doxorubici None No n + Gelfoam Trinchet 1995 Cisplatin + None No GelfoamBruix 1998 Coils and None No GelfoamPelletier 1998 Cisplatin + None No ethiodolTrinchet 1995 Cisplatin + None No GelfoamPelletier 1998 Cisplatin + None No ethiodolLo 2002 Cisplatin + None Yes ethiodolLlovet 2002 Doxorubici None Yes n + ethiodolNote: embo, embolization; FU, fluorouracil.Experimental Therapies Several therapies are being evaluated (Table 88-6). Epidermal growthfactor (EGF) receptor antibodies and EGF receptor kinase inhibitors are in clinicaltrials, as are various anti-angiogenesis therapies. No effects on survival are yetreported. Oral sorafenib increases median survival from 6 to 9 months inadvanced, unresectable HCC. Several forms of radiation therapy have been usedin the treatment of HCC, including external beam and conformal radiation therapy.Radiation hepatitis remains a significant dose-limiting problem. The pure beta 90emitter yttrium attached to either glass or resin microspheres has been assessedin phase II trials of HCC and has encouraging survival effects with minimaltoxicities. Randomized trials have yet to be performed. Vitamin K has beenassessed in clinical trials at high dosage for its HCC-inhibitory actions. This ideais based on the characteristic biochemical defect in HCC of elevated plasma levelsof immature prothrombin (DCP or PIVKA-2), due to a defect in the activity ofprothrombin carboxylase, a vitamin K–dependent enzyme. Two vitamin Krandomized controlled trials from Japan show decreased tumor occurrence. Patientparticipation in clinical trials aimed at assessing new therapies is encouraged.