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Low-dose aspirin in combination with transarterial chemoembolization in treatment of unresectable hepatocellular carcinoma
Background
Hepatocellular carcinoma (HCC) is the sixth and fourth common cancer in worldwide and Egypt. Transarterial chemoembolization (TACE) is standard treatment for unresectable HCC. Recent studies showed that TACE refractoriness impairs survival of HCC patients. Various strategies under investigation aim to improve the outcome of TACE, Aspirin demonstrated chemopreventive, antithrombotic and anti-inflammatory properties Moreover, it has been reported that aspirin may reverse apoptosis resistance in HCC cell lines.
Methods
This study includes 60 patients diagnosed as unresectable HCC indicted for TACE randomized in to two arms; control arm and aspirin arm. All patients have vascular and cellular compensated liver functions; platelets count ≥ 100,000, and normal prothrombin time. We excluded patients with bleeding tendency, gastrointestinal ulcers, portal hypertension, allergy or contraindication to aspirin. Aspirin arm patients received 75 mg of aspirin daily after meal for 3 months; we assessed feasibility, toxicity of aspirin, studied treatment response and disease progression.
Results
In this study there was no significant difference between the two arms regarding baseline patients’ characteristics. Regarding compliance to aspirin, 70% of patients were regular; regarding compliance to TACE, 60% of patients were compliant to TACE in aspirin arm versus 56.7% in control arm. Most of side effects of aspirin are of grade 1 gastrointestinal side effect. According to modified RECIST criteria, better responses achieved in aspirin arm; 10% of patients in aspirin arm had complete remission versus 6.7 %in control arm and 30% had partial response in aspirin arm versus 23% in control arm, 30% of patients in aspirin arm had disease progression versus 40% in control arm; however, the difference didn’t reach statistical significant level (p=0.806). 20% of patients in control arm developed portal vein thrombosis versus only 6.7% in aspirin arm. There was an improvement in progression free survival (PFS); the median PFS was not reached for aspirin arm versus 11 months for Control arm (P=0.035).
Conclusions
The use of adjuvant aspirin with TACE in patients with HCC is feasible and may be associated with longer PFS and a tendency of better TACE responses; however, larger sample size may yield stronger results.
Legal entity responsible for the study
Menoufia University.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
