Annals of Oncology 13:1771-1778, 2002
© 2002 European Society for Medical Oncology
Original Paper |
Gemcitabine and doxorubicin for the treatment of patients with advanced hepatocellular carcinoma: a phase III trial
1 Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei; 2 Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; 3 Division of Hematology/Oncology, Mackay Memorial Hospital, Taipei; 4 Department of Clinical Research, Eli Lilly and Company Taiwan, Taipei, Taiwan
Received 19 November 2001; revised 22 April 2002; accepted 13 May 2002
Background:
We determined the maximum tolerated dose (MTD) and then further evaluated the response rate and safety profile of gemcitabine (Gem) plus doxorubicin (Dox) in chemonaïve patients with advanced hepatocellular carcinoma (HCC).
Patients and methods:
Dose escalation was tested over four dose levels in each 21-day cycle: level 1 (Gem 1000 mg/m2 on days 1 and 8, Dox 30 mg/m2 on day 1), level 2 (Gem/Dox 1250/30), level 3 (Gem/Dox 1250/45) and level 4 (Gem/Dox 1250/60). The MTD was further evaluated in phase II.
Results:
Patients characteristics were: 47 men, three women; median age 53 years (range 2870); Zubrod performance status (PS) scores 01 (74%), PS 2 (26%); Okuda stage I (24%) and stage II (76%). Fifteen patients were enrolled in phase I: level 1 (n = 3), level 2 (n = 6), level 3 (n = 6), level 4 (n = 0). Level 2 was identified as the MTD. Dose-limiting toxicities included esophageal bleeding, grade 4 neutropenia and neutropenic fever. Of the 34 patients evaluable for response in phase II (of 35 total), there were four (11.8%) partial responses (95% CI, 0.8% to 22.8%) and six (17.6%) minor responses; nine (26.5%) had stable disease and 15 (44.1%) progressed. Sixteen per cent of patients had a decline of
50% in
-fetoprotein levels after treatment. Median survival and progression-free survival were 4.6 months (range 0.319.2) and 2.5 months (range 0.27.8), respectively, for 35 patients. Grade 3/4 hematological toxicities included anemia (45.7%), neutropenia (51.4%), thrombocytopenia (25.7%); febrile neutropenia (11.8%) and non-hematological toxicities were mild to moderate.
Conclusions:
Gemcitabine plus doxorubicin produces modest activity and moderate toxicity in this cohort of Chinese patients with advanced HCC.
Key words: chemotherapy, doxorubicin, gemcitabine, hepatocellular carcinoma
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