Tamoxifen does not improve survival in patients with hepatocellular carcinoma

Nowak AK, Findlay M, Culjak G, Stockler MR

Published Online:

January 21, 2009

Hepatocellular carcinoma (primary liver cancer) is a common cause of death from cancer world-wide. It is usually fatal in patients who cannot be treated with surgery or other local treatments. Tamoxifen is an anti-oestrogen drug, which has been tested in advanced hepatocellular carcinoma. The reviewers identified 10 trials assessing the effect of tamoxifen on survival, quality of life, tumour size, and treatment side effects in advanced hepatocellular carcinoma. Tamoxifen had no significant effect on survival or tumour size. Tamoxifen did not improve quality of life.

Abstract (click to read)

Background:

Hepatocellular carcinoma (primary liver cancer) is the third commonest cause of cancer mortality world-wide. Survival is poor for patients with advanced disease. Trials of tamoxifen for hepatocellular carcinoma have conflicting results.

Objectives:

To conduct a systematic review of the literature to assess the effect of tamoxifen on overall survival, quality-of-life, tumour response, and treatment toxicity in people with advanced hepatocellular carcinoma.

Search strategy:

We identified trials from The Cochrane Hepato-Biliary Group Controlled Trials Register (January 2004), The Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 3, 2003), and MEDLINE database (1966 to November 2003). We searched bibliographies of review articles and identified trials, and hand-searched abstracts from relevant other meetings.

Selection criteria:

All randomised clinical trials of treatment with tamoxifen compared to a control treatment without tamoxifen in people with hepatocellular carcinoma, including trials of tamoxifen versus placebo, tamoxifen versus best supportive care, and tamoxifen plus other treatment versus the same other treatment alone.

Data collection and analysis:

Three independent reviewers selected studies for inclusion, rated them for methodologic quality components (generation of allocation sequence; allocation concealment; blinding; and follow-up), and extracted data on the specified outcomes. Hazard ratios were derived for overall survival where possible. Meta-analysis was performed using a fixed-effect model.

Main results:

Ten randomised trials randomising 1709 patients were included. Tamoxifen versus placebo/no intervention had no significant effect on overall survival (hazard ratio 1.05; 95% CI 0.94 to 1.16; P = 0.4). This comparison showed no statistical heterogeneity (P = 0.2 and I2 = 25.9%). Subgroup analysis showed that tamoxifen tended to increase mortality in trials with three adequate/three methodological components (hazard ratio 1.15; 95% CI 0.99 to 1.34; P = 0.06), showed no significant effect in trials with two adequate/three methodological components (hazard ratio 1.00; 95% CI 0.84 to 1.18; P = 0.98), and tended to reduce mortality in trials with one or less adequate/three methodological components (hazard ratio 0.82; 95% CI 0.60 to 1.12; P = 0.2), although this may have been confounded by the use of higher doses of tamoxifen in the better quality trials. Tamoxifen was associated with adverse effects. One trial measured patient quality of life, but the results were not reported in detail.

Authors' conclusions:

These data do not support the use of tamoxifen for patients with hepatocellular carcinoma. Further research on the effects of tamoxifen in hepatocellular carcinoma does not seem warranted.

This record should be cited as:

Nowak AK, Findlay M, Culjak G, Stockler MR. Tamoxifen for hepatocellular carcinoma. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001024. DOI: 10.1002/14651858.CD001024.pub2

Assessed as up to date:

May 24, 2004

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Primary Review Group:

Hepato-Biliary Group

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tamoxifen does not improve survival in patients with hepatocellular carcinoma

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