Published online Jun 21, 2018. doi: 10.3748/wjg.v24.i23.2501
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
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).
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.
We want to provide a simple and effect way to determine a clinical protocol based on pharmacokinetic and pharmacodynamic studies.
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.
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.
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.
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.