HAIC Using Oxaliplatin Plus Fluorouracil/Leucovorin for Patients With Locally Advanced HCC

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and much more common in male than in female. Each year, the number of patients with HCC in China alone contributes to about 50% of the total cases and deaths in the world. In men, poor prognosis makes HCC the second most frequent cause of cancer-related mortality in less developed countries. Locally advanced or metastatic disease is found in 60%-70% of HCC patients at the time diagnosed, with a median survival time of only 3-4 months due to unavailability of potentially curative therapies. Therefore, treatments that can control the progression and improve the prognosis of advanced HCC are under great need in sufficient liver reservation. Recently, an oral multi-tyrosine kinase inhibitor sorafenib, was reported to significantly prolong overall survival (OS) and delay disease progression in patients with advanced HCC. To date, sorafenib is still the only standard treatment for advanced HCC approved by FDA. However, low response rates, modest survival advantages, high-level heterogeneity of individual response and relatively high cost, such limitations of sorafenib prohibit its widespread use in advanced HCC and more alternative therapies are highly required at present.

In fact, for the past 30 years, researchers never stop searching for effective chemotherapeutic agents for HCC, and a wide spectrum of cytotoxic drugs have been reported by a variety of studies, including doxorubicin, gemcitabine, capecitabine, 5-fluorouracil (5-FU), cisplatin and so on. Unfortunately, low and heterogeneous responses and the well-known toxic effects caused by chemotherapy severely slowed down the pace of drug development for HCC. Until last year, based on a multicenter randomized clinical trial known as the EACH study, Qin et al. reported that FOLFOX4 (oxaliplatin [OXA], leucovorin [LV], 5-FU) regimen was associated with significant better OS than doxorubicin regimen (5.7 vs. 4.3 months; hazard ratio: 0.74; P = 0.03) in Chinese subgroup that accounted for 75% of the EACH study population. This study has provided proof to suggest that the FOLFOX4 regimen may become a potentially more efficacious alternative to doxorubicin in Chinese patients with advanced HCC.

However, systemic toxicity of chemotherapy and impaired liver function is still a concern that could not be neglected. Compared with systemic chemotherapy, hepatic arterial infusion chemotherapy (HAIC) can provide chemotherapeutic agents to liver at higher concentration with lower toxicity and has been reported favor results in patients with advanced HCC. Additionally, for patients who are not initially eligible for curative treatment, e.g., resection or liver transplantation, HAIC may down disease stage and offer them a chance to undergo such treatment which gives good long-term results. Though various agents such as 5-FU and cisplatin were studied with HAIC, by far, there have been no data about the use of more effective regimens FOLFOX4 in HAIC. Therefore, we carried out a multi-center, prospective trial to investigate the effect and safety of HAI combined with FOLFOX4 regimens in Chinese population with advanced HCC.