Despite substantial response rates, formidable side effect usually developed in a great proportion of patients, deterring the clinical application of these regimens in far advanced HCC.
Docetaxel in combination with cisplatin (Roth et al, 2000; Ridwelski et al, 2001) or epirubicin (Andre et al, 1999) showed substantial response rates as first- and second-line chemotherapy in gastric cancer.
Various aspects related to both the survey design and the presentation of the questionnaire [ 23- 26, 29, 30] could explain this substantial incomplete response rate.
Results from nonrandomized studies with different chemotherapeutic agents or combination regimens given preoperatively demonstrated substantial clinical response rates but low pathologic tumor response rates.
The patients in this study, in which the most problematic tumours were selectively treated, had substantial tumour response rates to CDDP/epi gel even compared with patients with more favourable prognoses (Huber et al, 1995), and these responses were often accompanied by life-enhancing clinical benefits.
As non-response was not substantial (the overall response rate was 80% (7390/9250) in those invited to cognitive testing), however, major bias is unlikely.
A recent pilot trial found that continuous, low-dose GM-CSF had substantial activity (objective response rate 37%) in heavily pretreated patients with either metastatic breast cancer or female genital tract cancer (Kurbacher et al, 2005).
Analysis of non-respondents' demographic characteristics obtained from the survey company indicated that there was substantial difference in response rate by sex as well as by age: women were more likely to respond than men, and the response rate sharply increased with age, ranging from 1.0% for those aged 18 to 29 to 12% for those aged 65 or over.
Augmentation with lithium or second generation antipsychotics is an established practice in non-responders to antidepressant monotherapy, but is also associated with a substantial non-response rate and with non-tolerance.
Therefore, the substantial sample size, the response rate of 72.8%, and multivariate analysis are strengths of the present study.
