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Gemcitabine and oxaliplatin chemotherapy for advanced hepatocellular carcinoma after failure of anti-angiogenic therapies

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Summary

Background Sorafenib is the only systemic treatment that has shown a significant benefit in overall survival (OS) and in progression-free survival (PFS) in advanced hepatocellular carcinoma (HCC) patients. No standard of care currently exists for second-line treatment. The association of Gemcitabine-Oxaliplatine (GEMOX) has shown efficacy in the first-line setting. The aim of this study was to evaluate the efficacy of GEMOX after failure of at least one line of anti-angiogenic (AA) therapy. Patient and methods We performed a multicenter retrospective analysis of advanced HCC patients that received GEMOX chemotherapy after progression on at least one line of AA therapy. Results We analyzed a total of 40 patients that received a median of 7 cycles of GEMOX over a 6-year period. Grade 3/4 toxicity was observed in 25 % of patients, mainly neurotoxicity, thrombocytopenia and neutropenia in 12.5 %, 5 % and 5 % of patients respectively. Grade <3 toxicity was mainly hematological and neurotoxicity. In the sub-cohort of 35 patients evaluable for response, partial response was observed in 20 % of patients, while 46 % had stable disease. Median OS was 8.3 months, with a 6-month OS rate of 59 %. Median PFS was 3.1 months. Prognostic factors for OS in univariable analysis were the performance status and AFP levels at GEMOX start, and the BCLC score at diagnosis. None of these factors were prognostic for PFS or tumor response. Conclusion The GEMOX schedule seems to show clinical activity and an acceptable toxicity profile in advanced HCC patients who progressed after anti-angiogenic treatment. The observed median OS of over 8 months is encouraging in this population of heavily pretreated patients. These results would merit confirmation in a prospective randomized study.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oncologic Medicine, Gustave-Roussy, Villejuif, France

    Anna Patrikidou, Isabelle Sinapi, David Malka, Michel Ducreux & Valerie Boige

  2. Department of Biostatistics and Epidemiology, Gustave-Roussy, Villejuif, France

    Florence Fayard

  3. Department of Hepatology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine 75571 Paris Cedex 12, Paris, France

    Hélène Regnault & Laetitia Fartoux

  4. Department of Medical Oncology, Beaujon/Bichat University Hospital, Clichy, France

    Mohamed Bouattour & Sandrine Faivre

  5. Department of Cancer Medicine, Gustave-Roussy Institute, Cancer Campus, Grand Paris, University of Paris-Sud, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France

    Valerie Boige

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  1. Anna Patrikidou
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  2. Isabelle Sinapi
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  9. Michel Ducreux
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Correspondence to Valerie Boige.

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Patrikidou, A., Sinapi, I., Regnault, H. et al. Gemcitabine and oxaliplatin chemotherapy for advanced hepatocellular carcinoma after failure of anti-angiogenic therapies. Invest New Drugs 32, 1028–1035 (2014). https://doi.org/10.1007/s10637-014-0100-y

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