Treatment of primary hepatocellular carcinoma by hepatic arterial infusion of 4'-epirubicin

A group of 23 patients (20 male, 3 female) with hepatocellular carcinoma were treated by hepatic arterial infusion of 4'-epirubicin every 4 weeks. At each treatment, a catheter was inserted percutaneously into the main hepatic artery via the femoral artery under image intensification. Treatment consisted of a 24-h continuous HAI of epirubicin, 30 mg/m²/day for 3 days, without heparin. Eleven patients had only one infusion, 4 patients two infusions, 2 patients three infusions, 2 patients four infusions, and 1 patient six and eight infusions each. A partial response was seen in 3 patients, median duration 16 weeks (range 12-46 weeks). Seven patients remained stable, median duration 13 weeks (range 4-38 weeks). The median survival of the overall group was 18 weeks. Survival of responding, stable, and non-responding patients were 38 weeks, 19 weeks, and 10 weeks, respectively. Complications of catheter placement included asymptomatic dissection of the hepatic artery (3 patients), and asymptomatic thrombosis of the hepatic artery (3 patients). Eight patients experienced moderate nausea and vomiting, and 11 patients had moderate to severe alopecia. The granulocyte nadir was above 1000 μl in 83% of evaluable courses, 500-1000 μl in 6%, and less than 500 μl in 11% of courses. Two patients developed neutropenia-associated fever. A platelet nadir below 100,000/μl was seen after only 8% of courses, and only 1 patient had platelets below 50,000/μl. In conclusion, epirubicin has modest activity in hepatocellular carcinoma and is well tolerated when given by hepatic arterial infusion.