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 of Pittsburgh.
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(Drug information on iodine), or glass beads.
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.