Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: A retrospective matched-cohort study

Background: Hepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors. Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC. However, later reports declined any benefit. Objective: To study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC. Methods: This retrospective matched-cohort study was conducted at Tanta Cancer Center (TCC), Egypt where 116 advanced HCC cases treated with tamoxifen were compared to TNM stage and Child-Pugh class matched 116 HCC cases who received BSC. Results: The median OS in the tamoxifen group was 9.3 months (95% confidence interval [CI], 6.7–11.9 months) compared to 8.7 months (95%CI, 6.8–10.6) in the BSC group (p = 0.758). With univariate analyses, it was shown that absence of fatigue, Child-Pugh class A, single tumors, less advanced tumors (T2), and absence of metastases (M0), had significantly better OS than their counterparts. Multivariate analysis showed that absence of fatigue, Child-Pugh class A and T2 tumors were independent prognostic factors affecting OS. Tamoxifen produced partial response and clinical stabilization in one% and 16% of cases, respectively. The median PFS with tamoxifen was 7.2 months (95%CI, 5.2–9.5). Conclusions: Tamoxifen did not show any OS advantage in Egyptian patients with advanced HCC. Use of this drug is discouraged.