What's in the water: the disinfectant dilemma.

The interferons (IFNs) are glycoproteins which have, in addition to anti-viral activity, antiproliferative and immunomodulating properties (Borden, 1979; Billiau, 1981). The latter two suggested an anti-tumour potential for these substances and IFN has now been used in the treatment of a variety of malignant diseases. To date, there have been no reports of its use in human hepatocellular carcinoma (HCC). There is considerable epidemiological, serological and molecular biological evidence implicating the hepatitis-B virus in the aetiology of HCC (Kew, 1981), and this provides an additional reason for investigating the effects of IFN on the course of this tumour. We report a pilot trial of recombinant leucocyte alpha IFN (IFLrA; Hoffman la Roche) in the treatment of HCC. Sixteen patients with inoperable HCC were entered in the trial (Table I). With one exception, all were histologically proved. The exception (no. 16) was considered to have HCC on the basis of the clinical findings and a serum alpha-foetoprotein (AFP) concentration of 8 x 103 ng ml (normal <10). Five patients had a well-differentiated, 8 a moderately-differentiated, and 2 a poorlydifferentiated tumour. A trabecular pattern was present in 9 patients, a solid pattern in 3 and a scirrhous pattern in 3. One patient had a clear cell variant. The disease was confined to the liver in 13 patients and 3 had pulmonary metastases. All the patients conformed to required inclusion criteria with respect to haematological function (haemoglobin > 10gdl1, leucocyte count >3 x 10911 granulocytes > 10911, platelets > 30 x 10911) and renal function (blood urea and creatinine levels < 2.5 times upper limit of normal). Although hepatic function tests were abnormal, impairment was not severe enough to exclude these patients from the trial (prothrombin ratio > 2.5 times normal was considered to indicate severe hepatic impairment).