Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portalvein thrombosis or distant metastasis

BACKGROUND. Hepatocellular carcinoma (HCC) patients with major vascular inv olvement or extrahepatic metastasis are not good candidates for surgery or transarterial chemoembolization (TACE). In this study, the authors evaluate d the efficacy of combined therapy with intraarterial cisplatin infusion an d systemic administration of interferon-alpha (IFN-alpha) as a palliative t reatment for these patients. METHODS, Sixty-eight HCC patients with major portal vein thrombosis (n = 47 ) or distant metastasis (n = 27) were randomly allocated to 1 of 3 groups. Group I (n = 19) received combined therapy consisting of intraarterial cisp latin infusion and systemic IFN-alpha, Group n (n = 23) received intraarter ial cisplatin infusion, and Group III (n = 26) was managed with only suppor tive care. Cisplatin 2 mg/kg was infused through the proper hepatic artery every 8 weeks, and IFN-alpha 3 million IU/m(2) was administered subcutaneou sly 3 times a week. RESULTS. The partial response (defined as a 50% or greater reduction in the product of the 2 longest perpendicular tumor measurements) rate of Group I was significantly higher than that of Group II (33% vs. 14%; P < 0.05). Al so, the 1-year survival rate of Group I (27%) was higher than that of Group II (9%) or Group III (0%) (P < 0.05 and P < 0.01, respectively). The media n survival period of Group I was 19 weeks, which was significantly longer t han that of Group n (11 weeks) or Group III (5 weeks) (P < 0.05 and P < 0.0 1, respectively). CONCLUSIONS. These results suggest that combined therapy consisting of intr aarterial cisplatin infusion and systemic IFN-alpha may be useful as a pall iative treatment for HCC patients with major vascular involvement or extrah epatic metastasis. (C) 2000 American Cancer Society.