MONTREAL, Canada--Combining neoadjuvant chemotherapy and liver
transplantation appears to be a very encouraging approach for
patients with advanced stage primary hepatocellular carcinoma
(HCC), Brian I. Carr, MD, FRCP, PhD, said at the 19th International
Congress of Chemotherapy.
Results from a preliminary study show that a combination of the
two therapeutic modalities offers a significant improvement in
survival over liver transplantation alone for these patients,
who generally have a very poor prognosis, said Dr. Carr, professor,
Hepatobiliary Tumor Service, Transplant Institute, University
Initial efforts to improve survival in patients with advanced
primary HCC involved the selective delivery of chemotherapy through
the hepatic artery. Dr. Carr explained that unlike metastatic
cancer involving the liver, primary HCC is peculiar in that its
blood supply is fed almost completely by the hepatic artery, whereas
the normal liver is fed by the portal vein.
Blocking the Hepatic Artery
It was felt possible that the blood supply to the tumor could
be blocked by obstructing the hepatic artery, either by physical
ligation or by some agent such as gelatin, polyvinyl iodine, or
Unfortunately, this approach was only partially successful, Dr.
Carr said, since most patients with HCC have both cancer and cirrhosis,
and in cirrhosis patients, interfering with the hepatic artery
can be dangerous.
A phase I/II study was carried out in two steps to ascertain whether
chemotherapy and a new blocking agent, degradable starch microspheres,
would provide an effective and safer approach than previous techniques
for the treatment of primary HCC, Dr. Carr said.