Cyproheptadine use in hepatocellular carcinoma

Abstract

This study was conducted to compare the effectiveness of Cyproheptadine (CY) use in patients with different stages of HCC who received different therapeutic modalities; such a comparison has not been conducted by previous large, prospective, randomized studies. We conducted a cohort study using the Taiwan Cancer Registry Database for analysis. We included patients diagnosed as having HCC from January 1, 2002, to December 31, 2011. The patient cohort comprised those who received different treatments, and we compared patients who received CY with those who did not. In total, 70,885 patients were included, and the mean follow-up duration was 1.95 years. The adjusted hazard ratio (aHR) of all-cause deaths significantly decreased in all stages in the patients who received palliative treatments with CY use compared with those who received palliative treatments without CY use (all P < 0.0001 and aHR = 0.76, 0.80, 0.66, and 0.66 for stages I, II, III, and IV, respectively). Among the patients who received no treatment, CY use alone reduced the risk of all-cause deaths in stages I-IV (all P < 0.0001 and aHR = 0.61, 0.57, 0.54, and 0.52 for stages I, II, III, and IV, respectively). Among the patients with clinical stage I-II HCC (as determined by the American Joint Committee on Cancer) who received curative treatments, CY use did not reduce all-cause deaths. CY use might improve survival in patients with HCC receiving palliative treatments or no treatment regardless of clinical stages.

Keywords: Cyproheptadine; HCC; curative treatments; palliative treatments; stages.

Figure 1

Kaplan-Meier overall and disease-specific survival curves for patients with HCC undergoing different treatments. A. Kaplan-Meier overall and disease-specific survival curves for patients with HCC undergoing no treatment or no treatment with cyproheptadine. B. Kaplan-Meier overall and disease-specific survival curves for patients with HCC undergoing curative treatments or curative treatments with cyproheptadine. C. Kaplan-Meier overall and disease-specific survival curves for patients with HCC undergoing palliative treatments or palliative treatments with cyproheptadine.

Figure 2

Kaplan-Meier overall and disease-specific survival curves for patients with HCC undergoing different treatments (stratified by clinical stage). Kaplan-Meier curve-Stage I. A. Kaplan-Meier overall and disease-specific survival curves for patients with stage I HCC undergoing no treatment or no treatment with cyproheptadine. B. Kaplan-Meier overall and disease-specific survival curves for patients with stage I HCC undergoing curative treatments or curative treatments with cyproheptadine. C. Kaplan-Meier overall and disease-specific survival curves for patients with stage I HCC undergoing palliative treatments or palliative treatments with cyproheptadine. Kaplan-Meier curve-Stage II. D. Kaplan-Meier overall and disease-specific survival curves for patients with stage II HCC undergoing no treatments or no treatments with cyproheptadine. E. Kaplan-Meier overall and disease-specific survival curves for patients with stage II HCC undergoing curative treatments or curative treatments with cyproheptadine. F. Kaplan-Meier overall and disease-specific survival curves for patients with stage II HCC undergoing palliative treatments or palliative treatments with cyproheptadine. Kaplan-Meier curve-Stage III. G. Kaplan-Meier overall and disease-specific survival curves for patients with stage III HCC undergoing no treatments or no treatments with cyproheptadine. H. Kaplan-Meier overall and disease-specific survival curves for patients with stage III HCC undergoing curative treatments or curative treatments with cyproheptadine. I. Kaplan-Meier overall and disease-specific survival curves for patients with stage III HCC undergoing palliative treatments or palliative treatments with cyproheptadine. Kaplan-Meier curve-Stage IV. J. Kaplan-Meier overall and disease-specific survival curves for patients with stage IV HCC undergoing no treatments or no treatments with cyproheptadine. K. Kaplan-Meier overall and disease-specific survival curves for patients with stage IV HCC undergoing curative treatments or curative treatments with cyproheptadine. L. Kaplan-Meier overall and disease-specific survival curves for patients with stage IV HCC undergoing palliative treatments or palliative treatments with cyproheptadine.