Chemotherapy with etoposide, doxorubicin, cisplatin, 5-fluorouracil, and leucovorin for patients with advanced hepatocellular carcinoma

Jeng Nian Yuan, Yee Chao, Wei Ping Lee, Chung Pin Li, Rheun Chuan Lee, Full Young Chang, Sang Hue Yen, Lee Shou-Dong, Jacqueline Whang-Peng

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24 Citations (Scopus)


Background: To investigate the therapeutic index of combining etoposide, doxorubicin (adriamycin), cisplatin, 5-fluorouracil (5-FU), and leucovorin (EAPFL) chemotherapy in the treatment of advanced HCC, a trial of a novel schedule of triweekly administration was conducted. Patients and methods: Sixty-six patients with measurable advanced HCC, adequate liver and renal functions and adequate bone marrow reserves in whom local treatment was not indicated were studied. Triweekly EAPFL treatment consisted of a concomitant boost of etoposide 40 mg/m2 i.v. over 30 min on day 1, 2, and 3, doxorubicin 30 mg/m2 i.v. over 30 min on day 1 to a backbone regimen, triweekly PFL chemotherapy with cisplatin 60 mg/m2, 5-FU 1,200 mg/m2, and leucovorin 120 mg/m2 given simultaneously by a 72-h i.v. infusion. Response, survival, and toxicity were evaluated. Results: One patient had complete response (1%) and thirteen patients had partial response (20%). The objective response rate was 21% (95% confidence interval 11-31%). The median overall survival and median time to progression were 8.9 months and 3.3 months, respectively. Major treatment toxicities (grade 3-4) were neutropenia (28%), anemia (11%), thrombocytopenia (7%), hepatotoxicity (5%), vomiting (2%), and diarrhea (2%). There was no treatment-related death. Conclusion: Triweekly EAPFL chemotherapy is a moderately effective regimen with tolerable toxicities in the treatment of advanced HCC.

Original languageEnglish
Pages (from-to)201-206
Number of pages6
JournalMedical Oncology
Issue number2
Publication statusPublished - Jun 2008
Externally publishedYes



  • 5-fluouracil
  • Cisplatin
  • Doxorubicin
  • Etoposide
  • Hepatocellular carcinoma
  • Leucovorin

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Hematology

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