Search

The important factors in the causation of hepatocellular carcinoma (HCC) in Africa include hepatitis B virus (HBV), aflatoxin and possibly malnutrition. The evidence in support of an association of HBV with HCC is mainly epidemiological and includes: (a) the similarity between the geographical distribution of chronic carriers of hepatitis B surface antigen (HBsAg) and that of HCC; (b) the increased prevalence of HBV markers in the serum of patients with HCC when compared with the general population; and (c) the observation that HBV infection precedes the general development of the tumour and that HBV infection increases the risk of HCC over 200-fold. Laboratory evidence has shown that HBV DNA is integrated in the host tissue in patients with HCC. A vaccination programme in Senegal showed that hepatitis B vaccine reduced HBV infection and it is hoped that it will eventually lead to a reduction in HCC. Studies in East Africa have shown a correlation between aflatoxin contamination and the incidence of HCC. The possible roles of malnutrition and/or alcohol are discussed.

One hundred and thirty nine patients with histologically proven hepatocellular carcinoma (HC) were admitted to the Uganda Cancer Institute for treatment. The patients were considerably younger and seemed to have more advanced disease than HC patients in Europe and in North America. Of the 99 evaluable patients, 50 received Adriamycin intravenously; of these, 44% responded, with 10% achieving complete responses. Intraarterial Adriamycin tended to increase the response rate to 75%, but this may be merely a reflection of patient selection. Combination of Adriamycin with other drugs (dichloromethotrexate, 5-azacytidine, Rezoxane and cyclophosphamide) did not enhance its therapeutic effectiveness. The alphafetoprotein response curves observed when Adriamycin was combined with dichloromethotrexate suggested possible antagonisms between the two drugs. Hepatic artery ligation (HAL) is a good and simple palliative procedure with response rates similar to i.v. Adriamycin. However, the administration of Adriamycin after HAL tended to improve on response rates and survival. The toxicities observed were mainly myelosuppression, gastrointestinal disturbance, alopecia, and hyperpigmentation of the skin and mucous membranes.

In a Phase II clinical trial, 14 patients with histologically proven primary hepatocellular carcinoma were treated with adriamycin administered intravenously at a dose of 75 mg/m2 every 3 weeks. All 11 evaluable patients responded with 3 exhibiting complete tumor regression after two, three, and five courses of adriamycin respectively. The remission durations for these 3 were 3, 6, and 7 months, and their survivals were 8, 9, and 13 months, respectively. The median survival of the evaluable patients is 8 months (range 1-13 months). The side effects encountered included myelosuppression, anorexia, nausea, vomiting, and alopecia. Adriamycin seems to be an effective agent in hepatocellular carcinoma. Further trials are underway to test its true efficacy both singly and in combination with other drugs in the management of this tumor.