Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2018; 24(23): 2501-2507
Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2501
Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus
Lin-Zhong Zhu, Song Xu, Hai-Long Qian
Lin-Zhong Zhu, Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100142, China
Song Xu, Department of Radiology, Yunnan Second People’s Hospital, Kunming 650021, Yunnan Province, China
Hai-Long Qian, Interventional Therapy, Baotou Cancer Hospital, Baotou 014030, Inner Mongolia, China
Author contributions: Zhu LZ and Qian HL designed and performed this study; Zhu LZ analyzed the data; Xu S wrote the paper; Zhu LZ revised the manuscript for final submission.
Supported by the National Key R and D Program of China, No. 2016YFC0106604; and the National Natural Science Foundation of China, No. 81502591.
Institutional review board statement: The study was reviewed and approved by the Peking University Cancer Hospital’s Institutional Review Board.
Institutional animal care and use committee statement: The pharmacokinetics study was reviewed and approved by the Department of Laboratory Animal Science, Peking University Health Science Center.
Conflict-of-interest statement: The authors declare, to the best of our knowledge, no conflict of interest exists.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hai-Long Qian, MD, Doctor, Department of Interventional Therapy, Baotou Cancer Hospital, 18 Tuanjie Street, Qingshan District, Baotou 014030, Inner Mongolia, China.
Telephone: +86-472-5156644
Received: February 7, 2018
Peer-review started: February 7, 2018
First decision: February 24, 2018
Revised: March 9, 2018
Accepted: March 25, 2018
Article in press: March 25, 2018
Published online: June 21, 2018
Research background

We had generated a pharmacokinetics and pharmacodynamics model for transarterial infusion. Here, we aimed to translate these findings into a clinical protocol for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).

Research motivation

Although transarterial chemoembolization (TACE) is widely used in the treatment of HCC with PVTT, the incidence of complication is high and overall survival is short, thereby limiting its use. More safe and effective protocols need to be developed to improve therapeutic effects.

Research objectives

We want to provide a simple and effect way to determine a clinical protocol based on pharmacokinetic and pharmacodynamic studies.

Research methods

After embolization, we kept the catheter in the feeding artery of the tumor and infused chemotherapy: oxaliplatin 50 mg in 250 mL of glucose was infused by pump for 4 h and raltitrexed 2 mg in 100 mL of 0.9% saline for the next 1 h after.

Research results

All cases received low dose continuous hepatic arterial infusion chemotherapy without major complications. Complete responses, partial responses, stable disease, and disease progression for intrahepatic disease were observed in 0, 45, 20, and 21 patient, respectively. The 1-, 2-, and 3-year overall survival rates of the 86 patients were 40.7%, 22.1%, and 8.1% respectively, and the median survival time was 8.7 mo.

Research conclusions

TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be safely used in major portal vein tumor thrombosis (MPVTT) patients. It is effective in patients with advanced HCC with MPVTT and is less toxic.

Research perspectives

Continuous hepatic arterial infusion chemotherapy was shown to be effective with limited complications. Based on results from pharmacokinetic and pharmacodynamics studies; we were able to choose agents and adjust the protocol with high efficiency.