Although numerous treatment modalities have been explored in patients with advanced HCC, the therapeutic options are still limited. Somatostatin has been shown to have antimitotic activity in endocrine as well as in a variety of nonendocrine tumors. Expression of somatostatin receptors is found in HCCs, but the efficacy of the somatostatin analogue octreotide remains controversial. Therefore, a randomized double-blind placebo-controlled multicenter trial was performed to assess the efficacy of long-acting octreotide for the treatment of advanced HCC. One hundred twenty untreated patients with histologically confirmed HCC were randomized to receive either long-acting octreotide (Sandostation LAR 30 mg) intramuscularly every 4 weeks or placebo. The study groups were comparable with respect to clinical characteristics. There was no difference in the cumulative survival. The median survival time was 4.7 months in the octreotide group compared with 5.3 months in the control group. Six-month survival rates were 41% for octreotide patients and 42% for control patients, respectively. The unadjusted relative risk for mortality in the octreotide group compared with patients in the control group was 1.11 (95% CI 0.76-1.63; P ؍ 0.59). When adjusted for Okuda, CTP, and Cancer of the Liver Italian Program (CLIP) scores, the relative risk for octreotide did not change markedly and was 1.05 (95% CI 0.71-1.55; P ؍ 0.83). The CLIP score seems to predict survival better than both Okuda and CTP score.
Conclusion:
The randomized controlled double-blind HECTOR trial showed no survival benefit for HCC patients treated with long-acting octreotide compared with placebo.
(HEPATOLOGY 2007;45:9-15.) H CC is one of the major malignancies worldwide. High incidence areas include Eastern Asia, Central Africa, and some countries of Western Africa. 1 Recent studies have shown an increasing incidence in developed countries as well. 2 Liver transplantation or resection are the only potentially curative therapies. Due to advanced or decompensated cirrhosis, comorbidity, and multicentricity of the HCC, lesions in 70%-80% of patients are inoperable at the time of diagnosis. 3 Therefore, several local ablation methods have been developed as minimally invasive strategies for HCC treatment, including transarterial chemoembolization, percutaneous ethanol injection, and radiofrequency thermal ablation. 4 However, these therapies are not suitable for patients with advanced, large, or multicentric HCC, leaving systemic treatment as the only option. Systemic HCC therapy trials including intravenous chemotherapy or antioestrogenic drugs have been disappointing, however. 5 In a recent study of 58 patients, Kouroumalis et al. 6 reported significant improvement in survival in HCC patients treated with short-acting octreotide (analogue of the cyclic peptide hormone somatostatin [250 g subcutaneously, twice daily]) compared with best supportive care (median survival 13 mo and 4 mo, respectively; P ϭ 0.002). Stimulated by these results and the fact that there is no established systemic HCC treatment available, we