Capecitabine for treatment of advanced hepatocellular carcinoma

Background/Aims: Patients with advanced hepatocellular carcinoma (HCC) face a dismal prognosis, as no effective palliative chemotherapy exists. Moreover, treatment of patients with hepatocellular carcinoma presents a major challenge, because associated cirrhosis limits the choice of chemotherapeutic agents. We evaluated the activity and toxicity of capecitabine in patients with advanced hepatocellular carcinomas. Methodology: The authors performed a retrospective analysis of all patients with HCC who were treated with capecitabine. The medical records of patients with HCC who were treated at our institution between October 2002 and July 2005 were reviewed. Results: A total of eleven patients were treated with capecitabine. Eight patients had liver cirrhosis and Child-Pugh scores of A and B. Capecitabine was administered twice daily for 14 days at a total daily dose of 2000mg/m². Treatment was repeated every 21 days. Each patient received 2-16 treatment cycles. One partial response was observed (9%; 95% confidence interval (CI) 0.2-41.3%) and 3-month progression free survival rate was 27%. The median time to tumor progression and median overall survival were 2.2 months (95% CI 1.7-2.7 months) and 10.1 months (95% CI 3.0-17.2 months), respectively. The therapy was well tolerated, with hand-foot syndrome as the main toxicity. Grade 3 diarrhea occurred in one patient. Grade 3/4 hyperbilirubinemia was seen in five patients, but was mainly due to tumor progression. No other significant toxicities were observed. Conclusions: Capecitabine was found to be safe for treatment of patients with HCC, including those with compensated cirrhosis. However, the objective response rate was limited.