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Randomized Controlled Trial of Tamoxifen in Advanced Hepatocellular Carcinoma

From the Centre Hospitalier, Compiègne; Centre Hospitalo-Universitaire, Reims; Institut National de la Santé et de la Recherche Médicale, Equipe Mixte INSERM 106, Dijon; Centre Eugène Marquis, Rennes; Centre Hospitalo-Universitaire Ambroise Paré, Assistance Publique Hôpitaux de Paris; Centre Hospitalo-Universitaire, Clermont Ferrand; Institut Gustave Roussy, Villejuif; Centre Hospitalier Régional, Colmar; Centre Hospitalier Régional, Le Mans; Centre Hospitalier Régional, Pau; Fédération Francophone de Cancérologie Digestive; Centre Hospitalo-Universitaire; and Fédération Francophone de Cancérologie Digestive, Dijon, Association Nationale des Gastroentérologues Hospitaliers, France

Address reprint requests to Jean-Claude Barbare, Service d'Hépato-Gastroentérologie, Centre hospitalier, 8 avenue Henri Adnot, 60321 Compiègne, France; e-mail: jcbarbare001{at}ch-compiegne.rss.fr

PURPOSE: Randomized studies on tamoxifen treatment of hepatocellular carcinoma (HCC) produced conflicting results. The aim of this study was to assess the efficacy of tamoxifen administration in improving overall survival of patients with advanced HCC.

PATIENTS AND METHODS: A total of 420 patients with HCC who were not suitable for surgery or local treatment were randomly assigned between April 1995 and May 2000: 210 in the control group and 210 in the tamoxifen group (20 mg/d orally). Patients with WHO performance status greater than 2, belonging to Child-Pugh class C, or with serum creatinine greater than 130 µmol/L were not eligible.

RESULTS: Tolerance was good and the main reported adverse effects were thrombophlebitis (three patients), nausea (two patients), and hot flushes (three patients). Outcome did not differ between the two treatment arms: estimated median survival was 4.8 and 4.0 months in the tamoxifen and in the control groups, respectively (P = .25). Univariate analysis showed significant association of survival with age, Okuda stage, WHO performance status, Child-Pugh class, intrahepatic tumor stage, alpha-fetoprotein serum concentration, and presence of extrahepatic spread, portal vein thrombosis, hepatomegaly, or hepatalgia. In a Cox proportional hazards model we found a significant beneficial effect of tamoxifen on survival in patients belonging to Okuda I or II stages.

CONCLUSION: In this large study, tamoxifen did not improve the survival of patients with advanced HCC, but there is a suggestion that patients without major hepatic insufficiency seem to have some survival benefit. New trials involving this specific population are warranted.

Supported by a grant from Pharmacia S.A.S, Saint-Quentin en Yvelines, France.

Presented in part at the plenary session of the Journées Francophones de Pathologie Digestive, March 27, 2002, Nantes, France, and as a poster at the 38th Annual Meeting of American Society of Clinical Oncology, May 18-21, 2002, Orlando, FL.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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