Article Type

Original Study


Background: Hepatocellular carcinoma (HCC) accounts for between 85 and 90% of primary liver cancer. Surgery is considered curative treatment; however, local ablative technique has a high rate of recurrence. Different attempts are being tried to decrease time of recurrence with less side effects and toxicities. Metronomic chemotherapy is an emerging method of treatment with less side effects and good tolerability. Objectives: The aim of the study was to evaluate the effect and toxicity of metronomic capecitabine in HCC patients after localized intervention. Material and methods: This study included 30 patients with HCC who have been treated with locoregional interference (tranarterial chemoembolization, radiofrequency, or both) and have got complete response (CR) or partial response (PR). The patients were selected from the clinical oncology department, faculty of medicine, Menoufyia University; they received capecitabine 1000 mg/day continuously. Patient characteristics, disease-free survival, time to progression, effect of primary localized intervention on the outcome, and toxicity were evaluated using univariate and multivariable analysis. Results: Most patients were men with mean age of 54 years and hepatitis C virus positive (73%). Median disease-free survival was 8 months for patients who had CR after localized interference. Median time to progression was 8 and 4.4 months for CR and PR patients, respectively, which was statistically significant (P = 0.001). No grade IV toxicity was found. Grade III toxicity was hepatic toxicity (hyperbilirubinemia) and was found in three patients (10%); renal toxicity (elevated creatinine and urea) was found in one patient (3.3%); and one patient stopped due to deterioration of general condition. The most common hematological toxicity was thrombocytopenia grade I (50%) of the studied group. Four patients stopped treatment due to persistent grade III toxicity and one stopped it due to deteriorated performance. Effect of the initial response to localized treatment or the type of this localized intervention on the end outcome was insignificant. Conclusion: Metronomic capecitabine has a modest antitumor efficacy on HCC patients in CR or PR after localized intervention. However, because of its low toxicity profile, it deserves further attention as a convenient, outpatient-based chemotherapy regimen. We recommend more randomized controlled trials and phase III trials with comparative arm in larger populations.