Originally published as JCO Early Release 10.1200/JCO.2008.18.8151 on December 8 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chan, S. L. Articles by Yeo, W. Search for Related Content PubMed PubMed Citation Articles by Chan, S. L. Articles by Yeo, W. Social Bookmarking                            What's this?

New Utility of an Old Marker: Serial -Fetoprotein Measurement in Predicting Radiologic Response and Survival of Patients With Hepatocellular Carcinoma Undergoing Systemic Chemotherapy

Stephen L. Chan, Frankie K.F. Mo, Philip J. Johnson, Edwin P. Hui, Brigette B.Y. Ma, Wing M. Ho, Kwok C. Lam, Anthony T.C. Chan, Tony S.K. Mok, Winnie Yeo

From the State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; and Cancer Research UK Clinical Trials Unit at the University of Birmingham, Birmingham, United Kingdom

Corresponding author: Winnie Yeo, MD, Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; e-mail: winnie{at}clo.cuhk.edu.hk

Purpose There are limitations in using radiologic evaluation to assess the treatment outcome of patients with hepatocellular carcinoma (HCC). The use of serial -fetoprotein (AFP) in monitoring response has not been rigorously evaluated. We aimed to study the clinical value of AFP trend in an attempt to validate AFP as a surrogate serologic end point.

Patients and Methods Participants from a phase III randomized trial of systemic chemotherapy in HCC were studied. Serum AFP was prospectively collected in parallel with clinical and radiologic outcome. AFP response was defined as a decrease in AFP of more than 20% after a minimum of two cycles of chemotherapy. We studied the relationship between AFP response and treatment outcome in terms of radiologic response and overall survival.

Results Of 188 patients, 117 patients with elevated serum AFP (> 20 µg/L) and documented radiologic evaluation had received at least two cycles of chemotherapy. A total of 47 AFP responders were identified. AFP responders had better survival than nonresponders (13.5 v 5.6 months, respectively; P < .0001), and AFP response was strongly associated with radiologic response (P < .0001). Multivariate analysis suggested that AFP response was significantly associated with survival (hazard ratio, 0.413; 95% CI, 0.273 to 0.626; P < .0001). AFP responses were frequently observed in patients with radiologically stable disease (SD) and tended to identify a subgroup of SD patients with better survival.

Conclusion Serial AFP measurement is useful in prognostication and monitoring treatment response in HCC patients undergoing systemic chemotherapy. Incorporation of AFP response into the criteria evaluating treatment outcome should be considered in clinical practice and clinical trials of novel agents in HCC.

published online ahead of print at www.jco.org on December 8, 2008.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. R. Vora, H. Zheng, Z. K. Stadler, C. S. Fuchs, and A. X. Zhu Serum {alpha}-Fetoprotein Response as a Surrogate for Clinical Outcome in Patients Receiving Systemic Therapy for Advanced Hepatocellular Carcinoma Oncologist, July 1, 2009; 14(7): 717 - 725. [Abstract] [Full Text] [PDF]