2006, Number 4
<< Back Next >>
Ann Hepatol 2006; 5 (4)
Response of negative estrogen-receptor hepatocarcinoma to tamoxifen, and survival of non-resectable patients
García-Leiva J, Gamboa-Domínguez A, Ceron-Lizarraga T, Morales-Espinosa D, Meza-Junco J, Arrieta O
Language: English
References: 21
Page: 263-267
PDF size: 155.35 Kb.
Text Extraction
Hepatocellular carcinoma is the fifth most common malignant neoplasm worldwide. Most patients are not candidates to surgical treatment. The prognosis of this neoplasm is poor, with an overall survival rate of 8 weeks in unresectable tumors. Estrogen receptors have been found in up to 33% of this tumors, reason why treatment with tamoxifen or progesterone compounds have been tried to diminish this neoplasm’s progression but its use remains controversial. In our institution, thirteen patients were treated with tamoxifen (20-40 mg/day) and 26 received supportive measures only. The clinical and tumoral characteristics were similar
in both groups. Survival in the Tamoxifen group was of 5.5 ± 1.7 months while in the supportive measures group was of 2.1 ± 0.5 months (p = 0.018). Other factors related to an increased survival were: female gender and the Okuda score; age, TNM and αFP were not related to survival. The multivariate analysis showed that treatment with tamoxifen duplicates survival independently of the tumoral stage and functional hepatic reserve. It seems that the benefit of treatment with tamoxifen is limited and is not associated to the presence of estrogen receptors. In our study a 69 year-old man with diagnosis of non-resectable hepatocellular carcinoma and negative estrogen receptors, was treated with tamoxifen with a partial response and an overall survival of 4 years until November 2005. Despite some case reports that have shown tumoral regression, while other studies do not report any survival benefits. It is important to identify patients that would benefit from treatment with tamoxifen.
REFERENCES
Schafer DF, Sorrell MF Hepatocellular carcinoma. Lancet 1999; 353: 1252-1257.
Yu A, Keeffe EB. Management of hepatocellular carcinoma. Rev Gastrenterol Disord 2003; 3(1): 8-24.
Kew MC. Role of cirrhosis in hepatocarcinogenesis. In: Bannasch P, Keppler D, Weber G, (eds) Liver cell carcinoma. Dordrecht: Kluwer Academic Publishers 1989: 37-46.
Leung T, Johnson PJ. Systemic therapy for hepatocellular carcinoma. Semin Oncol 2001; 28: 514-520.
Aguayo A. Patt Yehuda Nonsurgical treatment of hepatocellular carcinoma. Semin Oncol 2001; 28: 503-513.
Mondragón-Sanchez R. Tamoxifen and hepatocarcinoma. Rev Gastroenterol Mex 1998; 63: 163-130.
Macaigne G, Auriault ML, Boivin JF, Cheaib S, Chayette C, Deplus R. Regression of hepatocellular carcinoma under tamoxifen: report of one case and review of literature. Gastroenterol Clin Biol 2002; 26(12): 1165-7.
Jiang SY, Shyu RY, Yeh MY, Jordan VC. Tamoxifen inhibits hepatoma cell growth trough an estrogen receptor independent mechanism. J Hepatol 1995; 23: 712-19.
Martínez CFJ, Tomas A, Donoso L, Enriquez J, Guarner C, Balanzo, Martinez NA et al. Controlled trial of tamoxifen in patients with advanced hepatocellular carcinoma. J Hepatol 1994; 20: 702-06.
Farinati F, Salvagnini M, De Maria N, Fornasiero A, Chiaramonte M, Rossaro L. Naccarato R, et al. Unresecable hepatocellular carcinoma: a prospective controlled trial with tamoxifen. J Hepatol 1990; 11: 297-301.
Elba S, Giannuzzi V, Misciagna G, Manghisi OG. Randomized controlled trial of tamoxifen versus placebo in inoperable hepatocellular carcinoma. Ita J Gatroenterol 1994; 26: 66-68.
Castells A, Bruix J, Bru C, Ayuso C, Roca M, Boix L, Vilana R, Rodes J, et al. Treatment of hepatocellular carcinoma with tamoxifen: a double-blind trial in 120 patients. Gastroenterology 1995; 109: 917-922.
Riestra S, Rodriguez M, Delgado M, Suarez A, Gonzalez N, de la Mata M, Diaz G, et al. Tamoxifen does not improve survival of patients with advanced hepatocellular carcinoma. J Clin Gastroenterol 1998; 26: 200-3.
CLIP Group (Cancer of the Liver Italian Programme) Tamoxifen in treatment of hepatocellular carcinoma: a randomized controlled trial. Lancet 1998; 352: 17-20.
Lai EC, Choi TK, Chen CH, Mok F, Fan S, Tan E, Wong J. Doxorubicin for unresectable hepatocellular carcinoma. A prospective study on the addition of verapamil. Cancer 1990; 66(8): 1685-7.
Gelmann EP. Tamoxifen for the treatment of malignancies other than breast and endometrial carcinoma. Semin Oncol 1997; 24: 165-170.
Liu CL, Fan ST, Ng IO, Lo CM, Pon RT. Wong J. Treatment of advanced hepatocellular carcinoma with tamoxifen and the correlation with expression of hormone receptors: A prospective randomized study. Am J Gastroenterol 2000; 95: 218-22.
Barbare JC, Bouché O, Bonnetain F, Raoul JL, Rougier P, Abergel A, Boige V, et al. Randomized controlled trial of tamoxifen in advanced hepatocellular carcinoma. J Clin Oncol 2005; 23: 4338-4346.
Chow PK, Tai BC, Machin D, Win KM, Johnson PJ. High doses tamoxifen in the treatment of inoperable hepatocellular carcinoma: A multicenter randomized controlled trial. Hepatology 2002; 36(5): 1221-6.
Manesis EK, Giannoulis G, Zoumbuulis P, Vafiadou I, Hadzivannis SJ. Treatment of hepatocellular carcinoma with combined suppression and inhibition of sex hormones: randomized controlled trial. Hepatology 1995; 21: 1535-1542.
Villa E, Colantoni A, Grottola A, Ferretti I, Buttafoco P, Bertani H, De Maria N, et al. Variant estrogen receptor and their role in liver disease. Mol Cell Endocrinol 2002; 193(1-2): 65-9.