Efficacy of bi-monthly hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma in patients with decompensated cirrhosis

Background: We have previously reported that the efficacy of bi-monthly hepatic arterial infusion chemotherapy (B-HAIC) was not inferior to that of sorafenib chemotherapy for the treatment of advanced hepatocellular carcinoma (aHCC) in patients with compensated cirrhosis. In this study, we demonstrate the efficacy of B-HAIC in patients with decompensated cirrhosis. Methods: Forty-five patients with aHCC refractory to transcatheter arterial chemo-embolization (TACE) were treated with B-HAIC and were divided into two groups according to the grade of their hepatic functional reserve: the Child–Pugh A group (n=21) and the Child–Pugh B group (n=24). The overall survival periods, curative responses, and adverse events in each group were retrospectively analyzed. Results: The efficacy rate and the disease control rate in the Child–Pugh B group (21% and 71%, respectively) were not significantly impaired compared with the rates in the Child–Pugh A group (38% and 67%, respectively). The median survival time and the survival rate at 12 months of patients in the Child–Pugh B group were 422 days and 58.3%, respectively, whereas those in the Child–Pugh A group were 567 days and 70.8%, respectively. Importantly, the hepatic functional reserve of patients in each group did not worsen during the treatment period. Furthermore, the occurrence rate of serious adverse events leading to discontinuation of anti-tumor treatment in both groups was quite limited despite the preserved hepatic functional reserve in these patients. Conclusions: Given the preservation of hepatic functional reserve afforded by B-HAIC chemotherapy, even in patients with decompensated cirrhosis, we suggest that B-HAIC might be acceptable as an alternative strategy for aHCC patients who do not respond to TACE.