Gemcitabine and oxaliplatin chemotherapy for advanced hepatocellular carcinoma after failure of anti-angiogenic therapies

Anna Patrikidou, Isabelle Sinapi, Hélène Regnault, Florence Fayard, Mohamed Bouattour, Laetitia Fartoux, Sandrine Faivre, David Malka, Michel Ducreux, Valerie Boige

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Sorafenib is the only systemic treatment that has shown a significant benefit in overall survival (OS) and in progression-free survival (PFS) in advanced hepatocellular carcinoma (HCC) patients. No standard of care currently exists for second-line treatment. The association of Gemcitabine-Oxaliplatine (GEMOX) has shown efficacy in the first-line setting. The aim of this study was to evaluate the efficacy of GEMOX after failure of at least one line of anti-angiogenic (AA) therapy. Patient and methods: We performed a multicenter retrospective analysis of advanced HCC patients that received GEMOX chemotherapy after progression on at least one line of AA therapy. Results We analyzed a total of 40 patients that received a median of 7 cycles of GEMOX over a 6-year period. Grade 3/4 toxicity was observed in 25 % of patients, mainly neurotoxicity, thrombocytopenia and neutropenia in 12.5 %, 5 % and 5 % of patients respectively. Grade <3 toxicity was mainly hematological and neurotoxicity. In the sub-cohort of 35 patients evaluable for response, partial response was observed in 20 % of patients, while 46 % had stable disease. Median OS was 8.3 months, with a 6-month OS rate of 59 %. Median PFS was 3.1 months. Prognostic factors for OS in univariable analysis were the performance status and AFP levels at GEMOX start, and the BCLC score at diagnosis. None of these factors were prognostic for PFS or tumor response. Conclusion: The GEMOX schedule seems to show clinical activity and an acceptable toxicity profile in advanced HCC patients who progressed after anti-angiogenic treatment. The observed median OS of over 8 months is encouraging in this population of heavily pretreated patients. These results would merit confirmation in a prospective randomized study.

Original languageEnglish
Pages (from-to)1028-1035
Number of pages8
JournalInvestigational New Drugs
Issue number5
StatePublished - Oct 2014
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Springer Science+Business Media 2014.


  • Angiogenesis inhibitor
  • Cirrhosis
  • Gemcitabine
  • Hepatocellular carcinoma
  • Oxaliplatin


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