Hormonal treatment of hepatocellular carcinoma

to the Editor

Letters

Hormonal

treatment

of hepatocellular

It wa, wirh grcn, imeres, thn, we rend the lender article

carcinoma

mconazole (8). The third. a double-blind study using a flut-

by Dr. Car, and Dr. Van Tbiel on hormonal manipulation of

amide analague or a long-acting LH-RH

human hepatocellular carcinoma (HCC).

was sponsored by the EORTC

Both estrogens and

agonist vs. placebo.

Oartrointerdnal

Tract Cancer

androgens may play an important role in controlling benign

Coopwaive

and neaples,ic liver growb

senled. will probably provide us with reliable information on

anti-androgen

and, in different smdies, barb

and anti-estrogen

Anti-estrogens.

na.sly

drugs have been tested.

tamoxifen.

have been used in six

studies: tour uncontrolled studies (I-4).

a controlled trial on

Group. The data from this study, no, ye, pn-

anti-androgen treatment in HCC. Thd results of these studies may well be influenced by several biases: patients studied ha&z hdd HCC associated&th

cirrhosis of &ious

etiology.

dororubicin and rnmoxifen vs. daxorubicin alone (5) and our

the stage of the disease has seldom been accurately asxssed.

own study. which also appeared in the Journal (6). Of the

both males and females have been included and the hormo-

four unc&olled

studied: the first reports a long-term re-

nal status has never been considered. In addition,

,o our

,be second “” extension of median

mind, the results of anti-sndrogen or and-estrogen lreatmen,

swvival to more than 8 months (4), and in the third and the

cannot be evaluated by adopting the usual criteria (reduction

sponse IO ,smoxife” (I,,

founh. stable disease was documented in 40 (‘21 and 25% of

of tumor mass). What we expect the administration

the pat!ents treated (3). respectively. In the latest study, four

drugs to cause is an interruption

patients had continuing long-term survival of 18, 22 and 39

stable disease, confirmed by imaging techniques or biahumorat data, and improvement in patients’ survival. A, this point,

of wch

of neaplastic growth, with

momhs. Dr. Melin’s paper reports a slight difference between doxorubicin alone and doxorubicin plus tamonifen,

unless rhe EORTC

wilb complete remission in one parien, treated with bath

are equally effective, we think that there is evidence enough

drugs accompanied by a dramatic and persistent reduction of

fha, anti-es,rogens are useful. at least in specific subgroups of

a-fetoprotein

levels (5). Our own sfudy has a catrolled

study demonstrates that anti-androgens

pro-

patients, while this is not true with respect to anti-androgens.

spective design (6). albeit based on a small, but statistically

Different combinations of drugs may be tested in the future.

sufficiem, &es

and includes patients uncharacterized horn

We have chosen a-2B interferon, a drugwhich hasbeen dem-

the point of view of hormonal status. Using life table analysis, om findings demonstrate a significant increase in survival, in

onstrated 10 increase estrogen-receptor expression and sensitivity to tamoxifen in human breast cancer cells (9).

patients treated with tamoxifen.

Also. our experience ap-

pears to confirm that the administration

of the drug is fat-

F. Farinati, N. De Maria. M. Chiaramonte,

lowed by a sharp and persistent reduction of a-fetoprotein, this being a marker of response to treatment. However, we are aware of three studies on anti-androgens in HCC. In one study using cyproterone acetate, the median survival of ,he patients was found to be 5 weeks and a reducdon of a-feto-

M. Salvapnini and R. Naccarato

protein levels was observed in only one paoen, just before

enterological Research’.

S. Fagiuoli,

Cuttedra MaLttie Appmm Digerenre, Is:iruro di Medicinn Inrerna, Policlinico Universimio, Via Gilrrtininni 2, 351W Pnduo. I&y Under the auspices of the ‘R. Farini Foundation for Gastro-

death (7). The second study reponed no advantages with ke-

9 van de” Berg HW. Leahey ws. Lynch M. Remmbina”, human interferon alpha increasesoestrogen receptor expressionin buma” bras, cancer cctls (2 R-75-1, and scnsidvesthem 10 ,he anriprolilerativc effectsoframoxife”. Br J Cancer ,987: 55.25-8.