Optimal choice of drug antitumor treatment in patients with Fibrolamellar liver carcinoma

Abstract

Introduction. Fibrolamellar hepatocellular carcinoma (FlC) is a rare subtype of hepatocellular carcinoma (HCC). Drug antitumor treatment of FlC has not been studied sufficiently due to the rarity of the pathology and requires further research to choose an effective treatment.Aim. The choice of effective drug antitumor treatment in patients with fibrolamellar liver carcinoma.Materials and methods. The retrospective study included 31 patients with FlC who received drug antitumor therapy at the N.N. Blokhin National Research Center of Oncology of the Ministry of Health of the Russian Federation in the period from 2005 to 2020. The patients were divided into comparison groups: “targeted therapy” (mainly sorafenib), “chemotherapy” (mainly gemcitabine + cisplatin). A comparative intergroup analysis of the effectiveness of drug antitumor treatment in the 1st and 2nd lines of therapy was carried out. Adjuvant chemotherapy was evaluated for time without progression. The correlation of the number of treatment lines in the anamnesis with the prognosis of the disease was also evaluated.Results. Analysis of the effect of adjuvant therapy on relapse-free survival did not prove significant differences between the comparison groups (p = 0.112; log-rank test). Therapy with multikinase inhibitors (mainly sorafenib) allows to achieve a better time without progression compared to chemotherapy (mainly gemcitabine + cisplatin / oxaliplatin) (p = 0.000; log-rank test) in patients in the 1st line of FlC treatment. OS did not significantly differ between the groups (p = 0.417; log-rank test). In line 2, time without progression in patients receiving targeted therapy (p = 0.042; log-rank test) is higher compared to patients receiving chemotherapy in line 2. A longer duration of OV was recorded in the groups of patients who underwent 2 lines of drug antitumor treatment and in the group of 3 or more lines compared with the use of only 1st line of treatment (p = 0.024) and (p = 0.003), respectively.Conclusion. The results of the work demonstrate an advantage in the appointment of targeted therapy as the 1st and 2nd lines of drug antitumor treatment, while the appointment of chemotherapy remains a less prognostically favorable option. Adjuvant therapy administration did not demonstrate a statistically significant difference in relapse-free survival.