Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma : a retrospective matched-cohort study

Abstract EN

Background : Hepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors.

Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC.

However, later reports declined any benefit.

Objective : To study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC.

Methods : This retrospective matched-cohort study was conducted at Tanta Cancer Center (TCC), Egypt where 116 advanced HCC cases treated with tamoxifen were compared to TNM stage and Child-Pugh class matched 116 HCC cases who received BSC.

Results : The median OS in the tamoxifen group was 9.3 months (95 % confidence interval [CI], 6.7–11.9 months) compared to 8.7 months (95 %CI, 6.8–10.6) in the BSC group (p = 0.758).

With univariate analyses, it was shown that absence of fatigue, Child-Pugh class A, single tumors, less advanced tumors (T2), and absence of metastases (M0), had significantly better OS than their counterparts.

Multivariate analysis showed that absence of fatigue, Child-Pugh class A and T2 tumors were independent prognostic factors affecting OS.

Tamoxifen produced partial response and clinical stabilization in one % and 16 % of cases, respectively.

The median PFS with tamoxifen was 7.2 months (95 %CI, 5.2–9.5).

Conclusions : Tamoxifen did not show any OS advantage in Egyptian patients with advanced HCC.

Use of this drug is discouraged.

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on behalf of National Cancer Institute, Cairo University.