Efficacy of combination chemotherapy with capecitabine plus cisplatin in patients with unresectable hepatocellular carcinoma

The aim was to assess the efficacy and safety of capecitabine (X) plus cisplatin (P) in patients with hepatocellular carcinoma (HCC). We retrospectively analyzed the data of 178 assessable among 195 consecutive HCC patients ineligible for curative therapy who were treated with XP at the National Cancer Center Korea between January 2002 and July 2007. One patient (0.5%) had modified UICC stage II tumors, 12 (6.7%) had stage III, 51 (28.7%) had stage IVa, and 114 (64.1%) had stage IVb. The overall response rate was 19.7%, and 45.0% achieved tumor growth control. Tumor response and disease stability were significantly higher in patients with serum alpha-FP < 400 ng/mL, those with CLIP score a parts per thousand currency sign 2, and those with a uninodular intrahepatic tumor or no residual intrahepatic tumor with extrahepatic tumors alone (P < 0.05). The median time to progression (TTP) and median overall survival were 2.8 months (95% CI 2.5-3.1 months) and 10.5 months (95% CI 7.9-13.1 months), respectively. Multivariate analyses showed that a uninodular or no residual intrahepatic tumor (hazard ratio, 0.524; P = 0.006) and female gender (hazard ratio, 0.539; P = 0.019) were independent predictors affecting TTP. Gastrointestinal symptoms were the most common grade 3 and 4 toxicities. Although XP chemotherapy produced moderate survival outcomes in advanced HCC patients, it was efficacious in the treatment of HCC patients with a uninodular or no residual intrahepatic tumor, especially women, regardless of extrahepatic tumor status.