Transhepatic arterial infusion chemotherapy using a combination of miriplatin and CDDP powder versus miriplatin alone in the treatment of hepatocellular carcinoma: a randomized controlled trialReportar como inadecuado




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BMC Cancer

, 17:322

Surgical oncology, cancer imaging, and interventional therapeutics

Abstract

BackgroundBased on promising results from a Phase I study of hepatic arterial infusion chemotherapy using a combination of miriplatin and cisplatin powder DDP-H for unresectable hepatocellular carcinoma UMIN-CTR000003541, a multicenter, open-label, randomized phase II study was conducted to evaluate the efficacy and safety of the combination therapy versus miriplatin monotherapy.

MethodsNineteen patients, five and fourteen Barcelona-Clinic Liver Cancer staging classification A and B cases, respectively, were randomly assigned to receive either miriplatin monotherapy n = 9 or miriplatin-DDP-H combination therapy n = 10. DDP-H and-or miriplatin were administered through the hepatic arteries supplying the lobes of the liver containing tumors, and progression free survival was analyzed as a primary end point in addition to other secondary endpoints. The corresponding therapy was repeated unless disease progression or severe adverse events were recorded.

ResultsThe monotherapy or combination therapy was performed for 15 or 36 sessions in total, respectively. Although there were no significant differences between the two groups for treatment intervals p = 0.96 or the dose of miriplatin used in each session p = 0.99, the progression free survival and overall disease control rate were significantly better in the combination therapy group 91 vs 423 days, p = 0.025; 40.0 vs 77.8%, p = 0.0025, respectively. Consistent with these observations, a trend of a significantly slower increase in des-γ-carboxyprothrombin was observed, and the number of treatment sessions was nearly significantly larger in the combination therapy group p < 0.0001, p = 0.057, respectively. Conversely, the median survival time did not show a significant difference 706 days, monotherapy vs 733 days, combination therapy; p = 0.40. A significant decrease in cholinesterase was observed during the course of treatment only in patients receiving combination therapy r = −0.86, p < 0.0001. A few cases in both arms showed hematological and-or non-hematological toxicities that were categorized as grade 1 NCI-CTCAE.

ConclusionsThe higher disease control effects with the combination of miriplatin and DDP-H indicate that it is a promising alternative treatment for cases with multiple HCCs, especially for those that can tolerate the treatment without experiencing a reduction in hepatic reserve.

Trial registrationThis study was registered on 1 January 2012 with the University Hospital Medical Information Network Clinical Trials Registry http:-www.umin.ac.jp-ctr-index.htm, UMIN000004691.

KeywordsHepatocellular carcinoma Interventional radiology Miriplatin Cisplatin powder Phase II clinical trial AbbreviationsAFPAlpha-fetoprotein

CDDPCisplatin

CIConfidence interval

DCPDes-gamma-carboxy prothrombin

DCRDisease control rate

DDP-HCisplatin powder

HAICHepatic arterial infusion chemotherapy

HCCHepatocellular carcinoma

L3%Percentage of fucosylated AFP versus total AFP

NCI-CTCAENational Cancer Institute Common Terminology Criteria for Adverse Events

OSOverall survival

PFSProgression free survival

TACETransarterial chemoembolization

TOCETransarterial oily chemoembolization





Autor: Kenya Kamimura - Takeshi Suda - Takeshi Yokoo - Hiroteru Kamimura - Tsutomu Kanefuji - Atsunori Tsuchiya - Masaaki Takamura

Fuente: https://link.springer.com/



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