Systemic doxorubicin and hepatocellular carcinoma: the end of an era never risen up
Mené sur 397 patients atteints d'un carcinome hépatocellulaire de stade avancé, cet essai de phase III évalue l'efficacité, du point de vue de la survie globale, et la toxicité de nanoparticules chargées en doxorubicine et dispensées par voie intraveineuse après l'échec d'un traitement par sorafénib (durée médiane de suivi : 22,7 mois)
Systemic therapy for hepatocellular carcinoma has dramatically evolved in the past couple of years. Since the survival benefit of sorafenib for advanced hepatocellular carcinoma was shown in 2007, several drugs have been tested in phase 3 trials with disappointing results. Accordingly, for a decade, sorafenib remained the only effective approved systemic therapy. Fortunately, the positive results with a second line of regorafenib, cabozantinib, and ramucirumab compared with best supportive care, and the demonstration of non-inferiority of lenvatinib compared with sorafenib as first-line treatment have increased the therapeutic armamentarium against this devasting neoplasia. Cytotoxic drugs such as fluorouracil, platinum salts, and particularly doxorubicin, assessed as single drugs, as combinations, or in combination with tyrosine kinase inhibitors, have produced disappointing results and prohibitive treatment-related toxicities. The safety concerns with doxorubicin are undoubtedly related to the presence of underlying cirrhosis in most patients with hepatocellular carcinoma, which impairs the hepatic metabolism of the drug and causes difficulties in clinical management.
The Lancet Gastroenterology & Hepatology , commentaire, 2018