Clinical effects of intra-arterial infusion chemotherapy with cisplatin, mitomycin C, leucovorin and 5-flourouracil for unresectable advanced hepatocellular carcinoma.

Background: Intra-arterial infusion chemotherapy (IAIC) can potentially improve survival in some patients with hepatocellular carcinoma (HCC), but the ideal regimen is not yet established. We prospectively evaluated the effects of short-course continuous infusion with the combination of cisplatin, mitomycin C, 5-fluorouracil (5-FU) and leucovorin for unresectable advanced HCC and analyzed their prognostic factors.

Methods: Patients with unresectable advanced HCC and not suitable for other therapy were enrolled. Cannulation via the left subclavian artery with the tip of catheter at the proper hepatic artery was done before initialization of IAIC routinely. The regimen consisted of the daily administration of cisplatin (10 mg/m2), mitomycin C (2 mg/m2), leucovorin (15 mg/m2), and daily infusion of 5-FU (100 mg/m2) for 5 days. Only the patients that had received at least 2 courses of IAIC were evaluated.

Results: Two-hundred and 11 courses of IAIC were performed, and each patient received at least 2 cycles of chemotherapy. The overall response rate was 28.3%. We observed a complete response in 5 patients (9.4%), a partial response in 10 patients (18.9%), a minimal response in 5 patients (9.4%), no change in 11 patients (20.8%) and a progressive disease in 22 patients (41.5%). The patients with response to treatment survived longer than the patients without response (24.6 +/- 14.2 months vs 8.7 +/- 5.3 months, p < 0.001). In univariate and multivariate analysis, absence of main vessel thrombosis and alpha-fetoprotein (AFP) reduction percentage > 50% following treatment showed significance in our study. All side effects subsided after conservative treatment.

Conclusions: Continuous IAIC with cisplatin, mitomycin-C, leucovorin, and 5-FU is effective for patients with severe advanced HCC. Absence of main vessel thrombosis, and AFP reduction percentage > 50% following treatment were good predictors of treatment response in our study. All side effects were mild and tolerable.