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Hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin vs. sorafenib for advanced hepatocellular carcinoma

  • Author Footnotes
    † These authors contributed equally to this study.
    Ning Lyu
    Footnotes
    † These authors contributed equally to this study.
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Author Footnotes
    † These authors contributed equally to this study.
    Yanan Kong
    Footnotes
    † These authors contributed equally to this study.
    Affiliations
    State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Luwen Mu
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Youen Lin
    Affiliations
    Department of Interventional Radiology, Jieyang Affiliated Hospital, Sun Yat-sen University, Jieyang, China
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  • Jibin Li
    Affiliations
    Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Yaru Liu
    Affiliations
    Medical Imaging Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Zhenfeng Zhang
    Affiliations
    Medical Imaging Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Lie Zheng
    Affiliations
    Medical Imaging Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Haijing Deng
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Shaolong Li
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Qiankun Xie
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Rongping Guo
    Affiliations
    Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Ming Shi
    Affiliations
    Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Li Xu
    Affiliations
    Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Xiuyu Cai
    Affiliations
    State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Peihong Wu
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Ming Zhao
    Correspondence
    Corresponding authors. Address: Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China. Tel.: +86 20 87343272; fax: +86 20 87343272.
    Affiliations
    Minimally Invasive Interventional Division, Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
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  • Author Footnotes
    † These authors contributed equally to this study.
Published:February 19, 2018DOI:https://doi.org/10.1016/j.jhep.2018.02.008

      Highlights

      • Hepatic arterial infusion was proven to be an effective and safe treatment in advanced HCC.
      • Hepatic arterial infusion therapy was an independent factor for PFS and OS.
      • Hepatic arterial infusion therapy provided a potential benefit of survival in patients with advanced HCC.

      Background & Aims

      To compare the overall survival (OS) and disease progression free survival (PFS) in patients with advanced hepatocellular carcinoma (Ad-HCC) who are undergoing hepatic arterial infusion (HAI) of oxaliplatin, fluorouracil/leucovorin (FOLFOX) treatment vs. sorafenib.

      Methods

      This retrospective study was approved by the ethical review committee, and informed consent was obtained from all patients before treatment. HAI of FOLFOX (HAIF) was recommended as an alternative treatment option for patients who refused sorafenib. Of the 412 patients with Ad-HCC (376 men and 36 women) between Jan 2012 to Dec 2015, 232 patients were treated with sorafenib; 180 patients were given HAIF therapy. The median age was 51 years (range, 16–82 years). Propensity-score matched estimates were used to reduce bias when evaluating survival. Survival curves were calculated by performing the Kaplan-Meier method and compared by using the log-rank test and Cox regression models.

      Results

      The median PFS and OS in the HAIF group were significantly longer than those in the sorafenib group (PFS 7.1 vs. 3.3 months [RECIST]/7.4 vs. 3.6 months [mRECIST], respectively; OS 14.5 vs. 7.0 months; p <0.001 for each). In the propensity-score matched cohorts (147 pairs), both PFS and OS in the HAIF group were longer than those in the sorafenib group (p <0.001). At multivariate analysis, HAIF treatment was an independent factor for PFS (hazard ratio [HR] 0.389 [RECIST]/0.402 [mRECIST]; p <0.001 for each) and OS (HR 0.129; p <0.001).

      Conclusion

      HAIF therapy may improve survival compared to sorafenib in patients with Ad-HCC. A prospective randomized trial is ongoing to confirm this finding.

      Lay summary

      We compared the hepatic arterial infusion of FOLFOX (a combination chemotherapy) with sorafenib (a tyrosine kinase inhibitor) in patients with advanced hepatocellular carcinoma, retrospectively. It was found that hepatic arterial infusion of FOLFOX therapy may improve both progression free and overall survival in patients with advanced hepatocellular carcinoma.

      Graphical abstract

      Keywords

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