Modified cisplatin/interferon α-2b/doxorubicin/5-fluorouracil (PIAF) chemotherapy in patients with no hepatitis or cirrhosis is associated with improved response rate, resectability, and survival of initially unresectable hepatocellular carcinoma

Authors

  • Ahmed O. Kaseb MD,

    1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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    • The first 2 authors contributed equally to this manuscript. Dr. Patt conceived and wrote the protocol.

  • Junichi Shindoh MD, PhD,

    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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    • The first 2 authors contributed equally to this manuscript. Dr. Patt conceived and wrote the protocol.

  • Yehuda Z. Patt MD,

    1. Department of Medicine, Division of Hematology and Oncology, University of New Mexico, Albuquerque, New Mexico
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  • Robert E. Roses MD,

    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Giuseppe Zimmitti MD,

    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Richard D. Lozano RPH,

    1. Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Manal M. Hassan PhD,

    1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Hesham M. Hassabo MD,

    1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Steven A. Curley MD,

    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Thomas A. Aloia MD,

    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • James L. Abbruzzese MD,

    1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Jean-Nicolas Vauthey MD

    Corresponding author
    1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Corresponding author: Jean-Nicolas Vauthey, MD, Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; Fax: (713) 745-1921; jvauthey@mdanderson.org.

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Abstract

BACKGROUND

The purpose of this study was to evaluate the factors associated with response rate, resectability, and survival after cisplatin/interferon α-2b/doxorubicin/5-fluorouracil (PIAF) combination therapy in patients with initially unresectable hepatocellular carcinoma.

METHODS

The study included 2 groups of patients treated with conventional high-dose PIAF (n = 84) between 1994 and 2003 and those without hepatitis or cirrhosis treated with modified PIAF (n = 33) between 2003 and 2012. Tolerance of chemotherapy, best radiographic response, rate of conversion to curative surgery, and overall survival were analyzed and compared between the 2 groups, and multivariate and logistic regression analyses were applied to identify predictors of response and survival.

RESULTS

The modified PIAF group had a higher median number of PIAF cycles (4 versus 2, P = .049), higher objective response rate (36% versus 15%, P = .013), higher rate of conversion to curative surgery (33% versus 10%, P = .004), and longer median overall survival (21.3 versus 10.6 months, P = .002). Multivariate analyses confirmed that positive hepatitis B serology (hazard ratio [HR] = 1.68; 95% confidence interval [CI] = 1.08-2.59) and Eastern Cooperative Oncology Group performance status ≥ 2 (HR = 1.75; 95% CI = 1.04-2.93) were associated with worse survival whereas curative surgical resection after PIAF treatment (HR = 0.15; 95% CI = 0.07-0.35) was associated with improved survival.

CONCLUSIONS

In patients with initially unresectable hepatocellular carcinoma, the modified PIAF regimen in patients with no hepatitis or cirrhosis is associated with improved response, resectability, and survival. Cancer 2013;119:3334–42 © 2013 American Cancer Society.

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