Hepatic Arterial Infusion Chemotherapy with Cisplatin for TACE-Refractory or -Ineligible Hepatocellular Carcinoma with Child-Pugh Score of 8 or Above

Abstract

Background: This study aimed to retrospectively assess the safety and usefulness of hepatic arterial infusion chemotherapy (HAIC) with cisplatin in patients with hepatocellular carcinoma (HCC) and Child-Pugh (C-P) score ≥ 8, who were refractory to or ineligible for transcatheter arterial chemoembolization (TACE). Methods: In this study, 28 cisplatin-naïve patients with HCC, C-P score ≥ 8, and no evidence of extrahepatic lesions were treated using HAIC with cisplatin between July 2004 and July 2013. Results: Of 28 patients, 10 were refractory to TACE and 18 ineligible for TACE. In terms of C-P score, 17 patients had a score of 8, 6 a score of 9, and 5 a score of 10. The injected dose of cisplatin was reduced in 64.3% of cases. The overall response rate was 10.7%, with a disease control rate of 35.7%. Overall, median survival time (MST) and progression-free survival were 186 and 80 days, respectively. In patients with macroscopic vascular invasion (MVI-positive; n = 9), these values decreased to 161 and 72 days, respectively; while they increased to 341 and 87 days, respectively, in MVI-negative patients (n = 19). Patients achieving partial response (PR) and stable disease (SD) status as well as those achieving SD status showed significantly better survival than patients with progressive disease (PD status): PR + SD vs. PD: MST = 447 vs. 123 days, P < 0.001; SD vs. PD: MST = 447 vs. 123 days, P = 0.001). No serious adverse event or treatment-related death occurred. Conclusions: HAIC with cisplatin can be safely administered in patients with HCC and C-P score ≥ 8, who are TACE-refractory or -ineligible. An extended survival time is expected when the treatment outcome is either SD or more favorable.