Exploring the efficacy of fluorouracil and platinum based chemotherapy in advanced hepatocellular carcinoma to bridge the treatment gap in resource limited settings

Advanced hepatocellular carcinoma (HCC) poses treatment challenges, especially where access to multi-kinase inhibitors and ICIs is limited by high costs and lack of insurance. This study evaluates the effectiveness of 5-fluorouracil (5-FU) plus platinum-based chemotherapy as an alternative systemic treatment for advanced HCC. A retrospective analysis of advanced HCC patients treated with 5-FU plus platinum-based chemotherapy was conducted. The Kaplan-Meier method determined median progression-free survival (PFS) and overall survival (OS). From April 2009 to October 2023, 48 patients with advanced HCC were included in the study. Nearly all patients (97.9%) had extrahepatic metastasis and stable liver function, with three-quarters previously treated with sorafenib. At a median follow-up of 7.8 months, the median PFS was 4.2 months (95% CI, 1.3-7.1), and the median OS was 8.2 months (95% CI, 2.5-13.9). A high pretreatment neutrophil-to-lymphocyte ratio (≥ 3.0) adversely affected both PFS (HR = 1.79; 95% CI, 0.99-3.25; p = 0.034) and OS (HR = 2.02; 95% CI, 1.10-3.69; p = 0.011). Hematologic toxicities related to the treatment were substantial, with 62.5% of patients experiencing grade 3 or 4 events, primarily neutropenia, which affected 60.4% of them. Our findings suggest that 5-FU combined with platinum-based chemotherapy is a viable, cost-effective alternative for advanced HCC treatment in resource-limited settings, particularly compared to ICIs and multi-kinase inhibitors, with significant implications for developing countries.