Difference between revisions of "Hepatocellular carcinoma"
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===References=== | ===References=== | ||
# Porta C, Moroni M, Nastasi G, Arcangeli G. 5-Fluorouracil and d,l-leucovorin calcium are active to treat unresectable hepatocellular carcinoma patients: preliminary results of a phase II study. Oncology. 1995 Nov-Dec;52(6):487-91. [http://www.ncbi.nlm.nih.gov/pubmed/7478436 PubMed] | # Porta C, Moroni M, Nastasi G, Arcangeli G. 5-Fluorouracil and d,l-leucovorin calcium are active to treat unresectable hepatocellular carcinoma patients: preliminary results of a phase II study. Oncology. 1995 Nov-Dec;52(6):487-91. [http://www.ncbi.nlm.nih.gov/pubmed/7478436 PubMed] | ||
+ | |||
+ | ==GEMOX== | ||
+ | GEMOX: '''<u>GEM</u>'''citabine, '''<u>OX</u>'''aliplatin | ||
+ | ===Regimen=== | ||
+ | *[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV on day 1 | ||
+ | *[[Oxaliplatin (Eloxatin)]] 100 mg/m2 IV over 2 hours on day 2 | ||
+ | |||
+ | '''14-day cycles, given until progression of disease, unacceptable toxicity, or patient choice''' | ||
+ | |||
+ | ===References=== | ||
+ | # Zaanan A, Williet N, Hebbar M, Dabakuyo TS, Fartoux L, Mansourbakht T, Dubreuil O, Rosmorduc O, Cattan S, Bonnetain F, Boige V, Taïeb J. Gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma: A large multicenter AGEO study. J Hepatol. 2013 Jan;58(1):81-8. doi: 10.1016/j.jhep.2012.09.006. Epub 2012 Sep 16. [http://www.sciencedirect.com/science/article/pii/S0168827812006952 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/22989572 PubMed] | ||
==Sorafenib (Nexavar)== | ==Sorafenib (Nexavar)== |
Revision as of 18:45, 16 January 2013
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Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.
Liver cancer or hepatobiliary cancer comprises cancers that arise within the liver and its hepatocytes (hepatocellular carcinoma) and the biliary tract cancers, which include bile duct cancer/cholangiocarcinoma and gallbladder cancer.
Hepatocellular carcinoma
Bevacizumab (Avastin)
Regimen
- Bevacizumab (Avastin) 5-10 mg/kg IV on day 1
14-day cycles
References
- Siegel AB, Cohen EI, Ocean A, Lehrer D, Goldenberg A, Knox JJ, Chen H, Clark-Garvey S, Weinberg A, Mandeli J, Christos P, Mazumdar M, Popa E, Brown RS Jr, Rafii S, Schwartz JD. Phase II trial evaluating the clinical and biologic effects of bevacizumab in unresectable hepatocellular carcinoma. J Clin Oncol. 2008 Jun 20;26(18):2992-8. link to original article contains verified protocol PubMed
Bevacizumab (Avastin) & Capecitabine (Xeloda)
Regimen
- Bevacizumab (Avastin) 7.5 mg/kg IV on day 1
- Capecitabine (Xeloda) 800 mg/m2 PO BID on days 1-14
21-day cycles x 6 or more cycles depending on response
References
- Hsu CH, Yang TS, Hsu C, Toh HC, Epstein RJ, Hsiao LT, Chen PJ, Lin ZZ, Chao TY, Cheng AL. Efficacy and tolerability of bevacizumab plus capecitabine as first-line therapy in patients with advanced hepatocellular carcinoma. Br J Cancer. 2010 Mar 16;102(6):981-6. Epub 2010 Feb 16. link to original article contains verified protocol PubMed
Bevacizumab (Avastin), Capecitabine (Xeloda), Oxaliplatin (Eloxatin)
Regimen
- Bevacizumab (Avastin) 5 mg/kg IV on day 1
- Infusion times for bevacizumab are 75-105 minutes for the first dose, which if tolerated could be decreased to 50-70 minutes for the second dose, then 20-40 minutes for dose 3 and later
- Capecitabine (Xeloda) 825 mg/m2 PO BID on days 1-14
- Oxaliplatin (Eloxatin) 130 mg/m2 IV over 2 hours on day 1
21-day cycles
References
- Sun W, Sohal D, Haller DG, Mykulowycz K, Rosen M, Soulen MC, Caparro M, Teitelbaum UR, Giantonio B, O'Dwyer PJ, Shaked A, Reddy R, Olthoff K. Phase 2 trial of bevacizumab, capecitabine, and oxaliplatin in treatment of advanced hepatocellular carcinoma. Cancer. 2011 Jul 15;117(14):3187-92. doi: 10.1002/cncr.25889. Epub 2011 Jan 24. link to original article contains verified regimen PubMed
Bevacizumab (Avastin) & Erlotinib (Tarceva)
Regimen
- Bevacizumab (Avastin) 10 mg/kg IV on days 1 & 15
- Erlotinib (Tarceva) 150 mg PO on days 1-28
28-day cycles
References
- Thomas MB, Morris JS, Chadha R, Iwasaki M, Kaur H, Lin E, Kaseb A, Glover K, Davila M, Abbruzzese J. Phase II trial of the combination of bevacizumab and erlotinib in patients who have advanced hepatocellular carcinoma. J Clin Oncol. 2009 Feb 20;27(6):843-50. Epub 2009 Jan 12. link to original article contains verified protocol PubMed
Capecitabine (Xeloda)
Regimen
- Capecitabine (Xeloda) 1000 mg/m2 PO BID on days 1-14
21-day cycles
References
- Patt YZ, Hassan MM, Aguayo A, Nooka AK, Lozano RD, Curley SA, Vauthey JN, Ellis LM, Schnirer II, Wolff RA, Charnsangavej C, Brown TD. Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer. 2004 Aug 1;101(3):578-86. link to original article contains verified protocol PubMed
CapeOx (XELOX)
CapeOX: Capecitabine, OXaliplatin
XELOX: XELoda, OXaliplatin
Regimen
- Capecitabine (Xeloda) 1000 mg/m2 PO BID on days 1-14
- Oxaliplatin (Eloxatin) 130 mg/m2 IV over 2 hours on day 1
21-day cycles
References
- Boige V, Raoul JL, Pignon JP, Bouché O, Blanc JF, Dahan L, Jouve JL, Dupouy N, Ducreux M; Fédération Francophone de Cancérologie Digestive. Multicentre phase II trial of capecitabine plus oxaliplatin (XELOX) in patients with advanced hepatocellular carcinoma: FFCD 03-03 trial. Br J Cancer. 2007 Oct 8;97(7):862-7. Epub 2007 Sep 18. link to original article contains verified protocol PubMed
Doxorubicin (Adriamycin)
Regimen
- Doxorubicin (Adriamycin) 60 mg/m2 IV on day 1
21-day cycles
References
- Gish RG, Porta C, Lazar L, Ruff P, Feld R, Croitoru A, Feun L, Jeziorski K, Leighton J, Gallo J, Kennealey GT. Phase III randomized controlled trial comparing the survival of patients with unresectable hepatocellular carcinoma treated with nolatrexed or doxorubicin. J Clin Oncol. 2007 Jul 20;25(21):3069-75. link to original article contains verified protocol PubMed
Fluorouracil (5-FU) & Folinic acid (Leucovorin)
Regimen
- Fluorouracil (5-FU) 370 mg/m2 IV on days 1-5
- Folinic acid (Leucovorin) 200 mg/m2 IV on days 1-5
28-day cycles
References
- Porta C, Moroni M, Nastasi G, Arcangeli G. 5-Fluorouracil and d,l-leucovorin calcium are active to treat unresectable hepatocellular carcinoma patients: preliminary results of a phase II study. Oncology. 1995 Nov-Dec;52(6):487-91. PubMed
GEMOX
GEMOX: GEMcitabine, OXaliplatin
Regimen
- Gemcitabine (Gemzar) 1000 mg/m2 IV on day 1
- Oxaliplatin (Eloxatin) 100 mg/m2 IV over 2 hours on day 2
14-day cycles, given until progression of disease, unacceptable toxicity, or patient choice
References
- Zaanan A, Williet N, Hebbar M, Dabakuyo TS, Fartoux L, Mansourbakht T, Dubreuil O, Rosmorduc O, Cattan S, Bonnetain F, Boige V, Taïeb J. Gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma: A large multicenter AGEO study. J Hepatol. 2013 Jan;58(1):81-8. doi: 10.1016/j.jhep.2012.09.006. Epub 2012 Sep 16. link to original article contains verified protocol PubMed
Sorafenib (Nexavar)
Regimen
- Sorafenib (Nexavar) 400 mg PO BID
- Dose/schedule changes of Sorafenib (Nexavar) due to toxicity include 400 mg PO daily, 400 mg PO every other day, 200 mg PO BID, 200 mg PO daily
given until progression of disease or unacceptable toxicity
References
- Abou-Alfa GK, Schwartz L, Ricci S, Amadori D, Santoro A, Figer A, De Greve J, Douillard JY, Lathia C, Schwartz B, Taylor I, Moscovici M, Saltz LB. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol. 2006 Sep 10;24(26):4293-300. Epub 2006 Aug 14. link to original article contains verified protocol PubMed
- Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Häussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J; SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008 Jul 24;359(4):378-90. link to original article contains verified protocol PubMed
- Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, Xu J, Sun Y, Liang H, Liu J, Wang J, Tak WY, Pan H, Burock K, Zou J, Voliotis D, Guan Z. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009 Jan;10(1):25-34. Epub 2008 Dec 16. link to original article contains verified protocol PubMed
- Pinter M, Sieghart W, Graziadei I, Vogel W, Maieron A, Königsberg R, Weissmann A, Kornek G, Plank C, Peck-Radosavljevic M. Sorafenib in unresectable hepatocellular carcinoma from mild to advanced stage liver cirrhosis. Oncologist. 2009 Jan;14(1):70-6. Epub 2009 Jan 14. link to original article contains verified protocol PubMed
- Cheng AL, Guan Z, Chen Z, Tsao CJ, Qin S, Kim JS, Yang TS, Tak WY, Pan H, Yu S, Xu J, Fang F, Zou J, Lentini G, Voliotis D, Kang YK. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: Subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer. 2012 Jan 10. [Epub ahead of print] link to original article contains verified protocol PubMed
Sunitinib (Sutent)
Regimen
- Sunitinib (Sutent) 37.5 mg PO daily on days 1-28
- Dose of Sunitinib (Sutent) can be reduced to 25 and 12.5 mg daily depending on toxicity
42-day cycles
References
- Zhu AX, Sahani DV, Duda DG, di Tomaso E, Ancukiewicz M, Catalano OA, Sindhwani V, Blaszkowsky LS, Yoon SS, Lahdenranta J, Bhargava P, Meyerhardt J, Clark JW, Kwak EL, Hezel AF, Miksad R, Abrams TA, Enzinger PC, Fuchs CS, Ryan DP, Jain RK. Efficacy, safety, and potential biomarkers of sunitinib monotherapy in advanced hepatocellular carcinoma: a phase II study. J Clin Oncol. 2009 Jun 20;27(18):3027-35. Epub 2009 May 26. link to original article contains verified protocol PubMed
Biliary tract cancer (cholangiocarcinoma/gallbladder)
Capecitabine (Xeloda)
Regimen
- Capecitabine (Xeloda) 1000 mg/m2 PO BID on days 1-14
21-day cycles
References
- Patt YZ, Hassan MM, Aguayo A, Nooka AK, Lozano RD, Curley SA, Vauthey JN, Ellis LM, Schnirer II, Wolff RA, Charnsangavej C, Brown TD. Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer. 2004 Aug 1;101(3):578-86. link to original article contains verified protocol PubMed
Capecitabine (Xeloda) & Mitomycin (Mutamycin)
Regimen
- Capecitabine (Xeloda) 1000 mg/m2 PO BID on days 1-14
- Mitomycin (Mutamycin) 8 mg/m2 IV bolus on day 1
28-day cycles
Supportive medications:
- Dexamethasone (Decadron) and 5-HT3 antagonists on the day of IV chemotherapy
References
- Kornek GV, Schuell B, Laengle F, Gruenberger T, Penz M, Karall K, Depisch D, Lang F, Scheithauer W. Mitomycin C in combination with capecitabine or biweekly high-dose gemcitabine in patients with advanced biliary tract cancer: a randomised phase II trial. Ann Oncol. 2004 Mar;15(3):478-83. link to original article contains verified protocol PubMed
ECF
ECF: Epirubicin, Cisplatin, Fluorouracil
Regimen
- Epirubicin (Ellence) 50 mg/m2 IV on day 1
- Cisplatin (Platinol) 60 mg/m2 IV on day 1
- Fluorouracil (5-FU) 200 mg/m2/day IV continuous infusion on days 1-21
21-day cycles
References
- Rao S, Cunningham D, Hawkins RE, Hill ME, Smith D, Daniel F, Ross PJ, Oates J, Norman AR. Phase III study of 5FU, etoposide and leucovorin (FELV) compared to epirubicin, cisplatin and 5FU (ECF) in previously untreated patients with advanced biliary cancer. Br J Cancer. 2005 May 9;92(9):1650-4. link to original article contains verified protocol PubMed
Fluorouracil (5-FU) & Folinic acid (Leucovorin)
Regimen
- Fluorouracil (5-FU) 500 mg/m2 IV bolus on days 1-2, given first
- Folinic acid (Leucovorin) 60 mg/m2 IV bolus on days 1-2, given second, 40 minutes after Fluorouracil (5-FU)
14-day cycles
References
- Glimelius B, Hoffman K, Sjödén PO, Jacobsson G, Sellström H, Enander LK, Linné T, Svensson C. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996 Aug;7(6):593-600. link to original article contains verified protocol PubMed
Fluorouracil (5-FU), Folinic acid (Leucovorin), Etoposide (Vepesid) (FELV)
FELV: Fluorouracil , Etoposide, LeucoVorin
Regimen #1, Rao, et al. 2005
- Fluorouracil (5-FU) 600 mg/m2 IV bolus on days 1-3, given first
- Folinic acid (Leucovorin) 60 mg/m2 IV bolus on days 1-3, given last
- Etoposide (Vepesid) 120 mg/m2 IV over 40 minutes on days 1-3, given second
21-day cycles
Regimen #2, Glimelius, et al. 1996
- Fluorouracil (5-FU) 500 mg/m2 IV bolus on days 1-3, given first
- Folinic acid (Leucovorin) 60 mg/m2 IV bolus on days 1-3, given last
- Etoposide (Vepesid) 120 mg/m2 IV over 40 minutes on days 1-3, given second
21-day cycles
References
- Glimelius B, Hoffman K, Sjödén PO, Jacobsson G, Sellström H, Enander LK, Linné T, Svensson C. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996 Aug;7(6):593-600. link to original article contains verified protocol PubMed content property of HemOnc.org
- Rao S, Cunningham D, Hawkins RE, Hill ME, Smith D, Daniel F, Ross PJ, Oates J, Norman AR. Phase III study of 5FU, etoposide and leucovorin (FELV) compared to epirubicin, cisplatin and 5FU (ECF) in previously untreated patients with advanced biliary cancer. Br J Cancer. 2005 May 9;92(9):1650-4. link to original article contains verified protocol PubMed
Fluorouracil (5-FU), Folinic acid (Leucovorin), Gemcitabine (Gemzar)
Regimen
- Fluorouracil (5-FU) 400 mg/m2 IV bolus, then 600 mg/m2 IV continuous infusion over 22 hours on day 1
- Folinic acid (Leucovorin) 100 mg/m2 IV over 2 hours on day 1
- Gemcitabine (Gemzar) 1000 mg/m2 IV on days 1 & 8
21-day cycles
References
- Gebbia V, Giuliani F, Maiello E, Colucci G, Verderame F, Borsellino N, Mauceri G, Caruso M, Tirrito ML, Valdesi M. Treatment of inoperable and/or metastatic biliary tree carcinomas with single-agent gemcitabine or in combination with levofolinic acid and infusional fluorouracil: results of a multicenter phase II study. J Clin Oncol. 2001 Oct 15;19(20):4089-91. link to original article contains verified protocol PubMed
Gemcitabine (Gemzar)
Regimen #1, Valle, et al. 2010
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes on days 1, 8, 15
28-day cycles x 3-6 cycles depending on response
Regimen #2, Gebbia, et al. 2001
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes on days 1, 8, 15
30-day cycles
References
- Gebbia V, Giuliani F, Maiello E, Colucci G, Verderame F, Borsellino N, Mauceri G, Caruso M, Tirrito ML, Valdesi M. Treatment of inoperable and/or metastatic biliary tree carcinomas with single-agent gemcitabine or in combination with levofolinic acid and infusional fluorouracil: results of a multicenter phase II study. J Clin Oncol. 2001 Oct 15;19(20):4089-91. link to original article contains verified protocol PubMed
- Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010 Apr 8;362(14):1273-81. link to original article contains verified protocol PubMed
Gemcitabine (Gemzar) & Cisplatin (Platinol)
Regimen
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes on days 1 & 8, given second
- Cisplatin (Platinol) 25 mg/m2 IV over 1 hour on days 1 & 8, given first
21-day cycles x 4-8 cycles depending on response
Supportive medications:
- Cisplatin is mixed in a solution of 1 liter of normal saline with 20 mmol potassium chloride, 8 mmol magnesium sulfate
- After cisplatin, 500 mL normal saline given over 30 minutes
References
- Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010 Apr 8;362(14):1273-81. link to original article contains verified protocol PubMed
Gemcitabine (Gemzar) & Mitomycin (Mutamycin)
Regimen
- Gemcitabine (Gemzar) 2000 mg/m2 IV over 30 minutes on days 1 & 15
- Mitomycin (Mutamycin) 8 mg/m2 IV bolus on day 1
28-day cycles
Supportive medications:
- Dexamethasone (Decadron) and 5-HT3 antagonists on the day of IV chemotherapy
References
- Kornek GV, Schuell B, Laengle F, Gruenberger T, Penz M, Karall K, Depisch D, Lang F, Scheithauer W. Mitomycin C in combination with capecitabine or biweekly high-dose gemcitabine in patients with advanced biliary tract cancer: a randomised phase II trial. Ann Oncol. 2004 Mar;15(3):478-83. link to original article contains verified protocol PubMed
GEMOX-B
GEMOX-B: GEMcitabine, OXaliplatin, Bevacizumab
Regimen
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 100 minutes on days 1 & 15, given second
- Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours on days 1 & 15, given last
- Bevacizumab (Avastin) 10 mg/kg IV on days 1 & 15, given first
28-day cycles
References
- Zhu AX, Meyerhardt JA, Blaszkowsky LS, Kambadakone AR, Muzikansky A, Zheng H, Clark JW, Abrams TA, Chan JA, Enzinger PC, Bhargava P, Kwak EL, Allen JN, Jain SR, Stuart K, Horgan K, Sheehan S, Fuchs CS, Ryan DP, Sahani DV. Efficacy and safety of gemcitabine, oxaliplatin, and bevacizumab in advanced biliary-tract cancers and correlation of changes in 18-fluorodeoxyglucose PET with clinical outcome: a phase 2 study. Lancet Oncol. 2010 Jan;11(1):48-54. Epub 2009 Nov 20. link to original article contains verified protocol PubMed