Chemotherapy of primary liver cancer

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Abstract
The therapy of primary liver cancer is still an unsolved problem. Until now, surgery has been the only therapeutic modality that can significantly increase the life‐span of patients in early stages of disease. Radiotherapy does not prolong the disease‐free interval. It is therefore important to explore possibilities of new therapeutic approaches, especially those of chemotherapy. Adequate trial data are available for methotrexate (MTX), 5‐fluorouracil (5‐FU), chloroethyl‐cyclohexyl‐nitrosourea (CCNU), methyl‐CCNU, hydroxyurea, cytosine arabinoside, dimethyltriazenoimidazole carboxamide, actinomycin D, mitomycin C, and adriamycin. These findings show that these substances when used as single agents are not very active in the treatment of primary liver cancer. Exceptions are MTX given intraarterially, adriamycin, 5‐FU, and their combination. Experimental agents are triethyleneglycol diglycidil ether, DL‐serine bis(2‐chloro‐propyl)carbamate ester, butyryloxyethylglioxal dithiosemicarbazone, cobaltiproto‐porphyrin, dehydroemetine, and mesylerythritol. New hopes can be attributed to the efforts made to the efforts made to design chemotherapy on a biochemical basis. Pyruvate kinase is an enzyme that is now considered an adequate target for cytostatic agents. Lykurim, which specifically blocks the activity of transaldolase, an enzyme having o key role in the metabolism of hepatomas, was also successfully used in pilot studies with patients with primary liver cancer.