Clinical Drug Experience Knowledgebase

Criteria

Inclusion Criteria:

Signing the informed consent form;
Diagnosed with HCC

Patients with hepatic cirrhosis must comply with AASLD (American Association for the Study of Liver Diseases) diagnostic criteria:

Typical radiological examination (ultrasonography, CT or MRI) manifestations: dynamic enhanced examination shows arterial-phase rapid heterogeneous enhancement and reduced venous-phase or delayed-phase rapid enhancement of space occupation in liver;

If the diameter of space occupation in liver is ≥2cm, the diagnosis can be established if any of radiological examinations shows the above HCC characteristics;
If the diameter of space occupation in liver is 1-2cm, the diagnosis can be established only when two radiological examinations show the above HCC characteristics;
If the diameter of space occupation in liver is≤1cm, histopathological examination is needed for establishing the diagnosis.

Histopathological examination is needed for establishing the diagnosis for patients without hepatic cirrhosis.

Stage Barcelona C
Grade A or B Child-Pugh score
ECOG PS score is 0-1
At least one measurable focus in liver according to (M) RECIST 1.0 criteria
Male or female, age>18
Can orally take drugs
Anticipated survival≥12 weeks
Pregnancy test of women at child-bearing ages must be negative within the 7 days before treatment
Male or female patients included must take effective contraceptive measures during the study period and within 4 weeks after completion of the study

Within the 7 days before inclusion, bone marrow, liver and kidney functions must satisfy the following requirements:

Hemoglobin≥ 90 g/L
Absolute neutrophil count (ANC) >1,500/mm3
Platelet count≥ 80x109/L
Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) < 5 times the upper normal limit (UNL)
Total bilirubin < 3UNL
Alkaline phosphatase < 4UNL
Serum creatinine < 1.5 UNL
Amylase and lipase < 2 UNL
INR<2.3 or PPT< 1.5 UNL (Patients who are accepting Warfarin or heparin anticoagulant therapy may be included if no evidence is available proving the above indicators are abnormal, but intense monitoring must be exercised. Tests shall be carried out at least once per week until stable INR.)

Exclusion Criteria:

Early or middle-stage primary HCC

Any contraindication of TACE therapy

Known hepatofugal blood flow
Known portal-systemic shunt
Abnormal coagulation test (PLT<6000/mm3, thrombogen activity<50%)
Renal failure or renal insufficiency necessitating dialysis
Serious atherosclerosis
Foci having undergone local treatment (e.g. resection, RFA, PEI or argon-helium cryoablation) cannot be used as the target foci
Local therapy or systemic chemotherapy within 4 weeks before inclusion or during the study period
Acute toxic reaction of CTC grade AE2 or above in any local treatment before inclusion

History of heart diseases:

Congestive heart failure of NYHA grade 2 above
Symptomatic coronary artery disease
Arrhythmia needing treatment with β blockers or drugs other than digoxin
uncontrollable hypertension
HIV infection or AIDS-related diseases
Serious active infections other than hepatitis B and hepatitis C (NCI-CTCAE 4.0 grade 2 above)
Gastrointestinal hemorrhage event within 4 weeks before inclusion
Thrombogenesis or embolism event within 6 months before inclusion, e.g. cerebral vascular accidents (including TIA), deep venous thrombogenesis or pulmonary embolisms
Past or present history of concomitant tumors completely different from HCC in primary lesions or histology, excluding head and neck carcinoma in situ, cured basal cell carcinoma, superficial bladder carcinoma (Ta, Tis, T1) and tumors having been cured 3 years before inclusion
Drug abuse, or psychological or mental diseases that may interfere with the study compliance
Known or suspected allergy to the study drug or concomitant medications
Contraindications of S-1
Pregnancy or lactation
Any disease that may affect evaluation of the study drug
Any instability or condition that may impair the patient's safety and compliance in the study
Gastrointestinal diseases affecting absorption or pharmacokinetics
Conditions restricting the patient from taking drugs orally, including serious upper gastrointestinal obstruction
Having accepted TACE before inclusion
Having taken S-1 before inclusion
Having accepted liver radiotherapy before inclusion or during the study period
Having accepted biological regulators, e.g. G-CSF, within the 3 weeks before inclusion
Having accepted autologous bone marrow transplantation or stem cell transplantation within 1 year before inclusion
History of homoplastic transplantation
Any drug that may affect absorption or pharmacokinetics of the study drug
Poor compliance considered by the investigator