Clinical Outcome of a Cohort of 63 Patients with Hepatocellular Carcinoma Treated with Octreotide

 

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Abstract

Unresectable hepatocellular carcinoma (HCC) are associated with a poor prognosis. Recently, one controlled study reported a strikingly prolonged survival of patients with HCC who were treated with octreotide. Until other randomised controlled trials become available, this multicentric retrospective study therefore assesses the outcome of HCC-patients who received octreotide treatment.

63 patients (53males, 10 females) who had been treated with octreotide at 13 participating German centres were included in the analysis. In 54 cases liver cirrhosis was present (25 Child-Pugh A, 20 Child-Pugh B, 7 Child-Pugh C, 2 unknown). The liver disease was associated with alcohol abuse in 19 patients, alcohol and viral hepatitis in four patients, while 12 patients had only markers of past or present hepatitis B infection, 11 patients suffered of chronic hepatitis C infection, and four patients were seropositive for both hepatitis B and hepatitis C markers. The Okuda stage was stage I in 23, stage II in 33, and stage III in 7 patients.

The patients initially received octreotide as a long-acting release formula (20-30 mg/month) in 43 cases or through subcutaneous injection (dose 3 x 50-3 x 300 ug/day) in the remaining cases. 11 of the patients receiving subcutaneous treatment were later converted to the long-acting release form of the drug.

At three months, a partial remission was achieved in two patients, while 22 tumours showed no change and 26 tumours progressed. At six months, 11 tumours showed no change, while 15 tumours progressed.

The patients’ median survival was 9 months (Okuda stage I 16 months, stage II 9 months, stage III 4 months). In conclusion, octreotide treatment did not result in markedly prolonged survival in this retrospective series of 63 patients.

Zusammenfassung

Das unresezierbare hepatozelluläre Karzinom (HCC) hat eine schlechte Prognose. Eine kürzlich veröffentlichte Studie hat einen deutlichen Überlebensvorteil octreotidbehandelter Patienten gezeigt. Bevor weitere randomisiert-kontrollierte Studien zur Verfügung stehen, untersucht diese retrospektive, multizentrische Studie den Verlauf octreotidbehandelter Patienten.

63 Patienten (53 Männer, 10 Frauen), die an 13 teilnehmenden deutschen Zentren mit Octreotid behandelt worden waren, wurden in die Studie aufgenommen. 54 der Patienten waren Leberzirrhotiker (25 Child-Pugh A, 20 Child-Pugh B, 7 Child-Pugh C, 2 unbekannt). Ursache der Lebererkrankung war ein Alkoholabusus bei 19 Patienten und eine Kombination aus Alkohol und Virushepatitis bei vier Patienten. 12 Patienten wiesen Marker auf, die auf einen Kontakt mit dem Hepatitis-B-Virus hinwiesen, 11 Patienten waren mit Hepatitis C infiziert und vier Patienten wiesen sowohl Hepatitis-B- als auch Hepatitis-C-Marker auf. Das Okuda-Stadium war I bei 23, II bei 33 und III bei 7 Patienten.

43 der Patienten erhielten Octreotid in Depotform (20-30 mg/Monat) und die übrigen Patienten erhielten subkutane Injektionen (Dosis 3 x 50-3 x 300 ug/Tag). 11 der Patienten, die anfangs subkutane Injektionen erhielten, wurden später auf Octreotid in Depotform umgestellt.

Nach drei Monaten konnten ein partielles Ansprechen bei zwei Patienten, keine Veränderung bei 22 Patienten und ein Tumorprogress bei 26 Patienten festgestellt werden. Nach sechs Monaten zeigten 11 Tumoren keine Veränderung und 15 Tumoren zeigten einen Progress. Das mediane Patientenüberleben betrug 9 Monate (Okuda-Stadium I 16 Monate, Stadium II 9 Monate, Stadium III 4 Monate).

Zusammenfassend konnte in der vorliegenden retrospektiven Serie von 63 Patienten kein deutlich verlängertes Überleben octreotidbehandelter Patienten aufgezeigt werden.

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Dr. C. Rabe

Sigmund-Freud-Straße 25

53105 Bonn

Germany

Email: Rabe@uni-bonn.de