Efficacy of bi-monthly hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma

According to the worldwide survey of World Health Organization in 2015, hepatic cancer (causing 0.79 million deaths per year) was the second-largest cause of cancer death, following lung cancer (1.69 million deaths per year) (http://www.who.int/mediacentre/factsheets/fs297/en/, Accessed 22 Dec 2017). Hepatic cancer is clinically silent during its early stages, making it difficult to detect promptly unless regular mechanical examinations like ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) are performed. The anti-tumor agent sorafenib, shown to be useful for advanced hepatocellular carcinoma (HCC) in 2008 (1), is the only established first-line chemotherapeutic agent. However, sorafenib affects the patient’s hepatic functional reserve because of its metabolism (2), and the decision to use it requires prior appropriate assessments of hepatic functional reserve. Selective transcatheter arterial chemo-embolization (TACE) has been widely applied as a treatment for HCC but a large-scale randomized case control study proving its efficacy and superiority is lacking, and reports have shown a positive correlation between TACE treatment and the loss of hepatic functional reserve (3-5). Most patients with advanced HCC have limited normal hepatic function and concomitant disease, and their prognosis depends in part on their levels of hepatic functional reserve