Sober N Clean

Survival time rose with combo therapy for advanced disease, study finds

By combining a special type of chemotherapy (TACE) with another treatment called radiofrequency ablation (RFA), Chinese researchers boosted the survival of people with advanced liver cancer by an average of 13 to 15 months compared to either treatment alone.

"Our study demonstrates that combination therapy with TACE and RFA was an effective and safe treatment that may improve long-term survival for patients with hepatocellular carcinoma larger than three centimeters," said Dr. Bao-Quan Cheng, from the Qilu Hospital and Shandong University School of Medicine in Jinan, China.

Results of the study were published in the April 9 issue of the Journal of the American Medical Association.

Hepatocellular carcinoma is responsible for as many as 90 percent of all liver cancers, according to the U.S. National Institutes of Health. Cirrhosis of the liver, often caused by hepatitis B or C or alcoholism, is usually at the root of such cancers. Cirrhosis can make treatment for this type of cancer more difficult, because it damages the liver so much that the liver can't process medications effectively. Only 10 percent to 20 percent of these cancers can be successfully treated with surgery.

For those whose tumors can't be removed with surgery, liver transplantation, chemotherapy and radiofrequency ablation are all options. TACE (transarterial chemoembolization) is a special type of chemotherapy that delivers chemotherapy drugs directly to the blood vessels feeding the tumor. Radiofrequency ablation uses electrodes to produce heat and destroy cancerous tissue.

The most commonly used treatment in the United States for advanced liver cancer is transplantation, according to Dr. Milan Kinkhabwala, chief of abdominal transplantation at Montefiore Medical Center in New York City. "If the tumor can't be resected [surgically removed], liver transplantation is the definitive treatment," he said, adding that transplantation might not be as available in China as it is in the United States.

Although TACE and RFA used individually can extend survival, the Chinese researchers hoped that by combining the techniques, they could increase survival times even more.

In a randomized, controlled trial, the researchers used one of three treatment techniques on people with hepatocellular carcinoma larger than 3 centimeters. Ninety-six people were assigned to the TACE-RFA combination, 95 to TACE alone and 100 to RFA alone.

Average survival time was 37 months for the combination therapy group compared to 24 months for TACE alone and 22 months for RFA alone.

The rate of responses lasting for at least six months rose to 54 percent in the combination group, versus 35 percent for the TACE group and 36 percent for the RFA group, the researchers found.

Side effects were similar between the groups, though RFA had the lowest rate of certain side effects, such as a low white blood cell count.

Cheng cautioned that these results may not be as applicable in the Western world, such as the United States or Japan, because the underlying cause of liver cancer in China is hepatitis B, whereas in the Western world, it tends to be hepatitis C or alcohol abuse. He hopes that similar clinical trials will be performed in the United States, Europe or Japan to see if the results are the same.

"Many of us have become aware that the standard approach of attacking a tumor with one modality isn't as good. Multimodal therapy is the new buzzword in cancer treatment," said Kinkhabwala. "It's really a belt-and-suspenders approach. You're targeting the tumor in different ways. This paper is important, because it's the first to look at this combination in a controlled way, and the combo approach does work. This confirms what our expectations were."

Kinkhabwala said he'd also like to see how a combination of these therapies with the new targeted medication, sorafenib (Nexavar), could affect outcomes. "Combining sorafenib with either or these or using all three might give better survival," he said.
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source: Health Scout