Ablative Chemoembolization for Hepatocellular Carcinoma: A Prospective Phase I Case-Control Comparison with Conventional Chemoembolization

Abstract

Purpose To evaluate the feasibility, safety, and treatment effectiveness of ablative chemoembolization (ACE) in the treatment of hepatocellular carcinoma (HCC) and compare with a similar patient cohort who underwent conventional transarterial chemoembolization (cTACE). Materials and Methods This was a prospective phase I nonrandomized study conducted between March 2013 and October 2016 in accordance to the Declaration of Helsinki and Declaration Good Clinical Practice with written informed consent. There were 36 men and eight women (median age, 64 years [interquartile range, 58-74] and 74.5 years [interquartile range, 70-80], respectively). The primary end points were treatment safety and tumor response. The secondary end points were time to progression, progression-free survival, conversion to partial hepatectomy, and viable HCC within the tumor specimen. The end points of the study group (n = 22) were compared with those of a case-matched control group (n = 22) of patients who underwent conventional cTACE during the same period by using a Pearson χ test. Results Treatment with ACE was successfully completed in all patients without adverse effects. The complete response (CR) rates by patient or by tumor were both 100%. The median time to progression and median progression-free survival were significantly longer in the study group than in the control group (both were 28 months vs 10 months, respectively; P < .001). The number of patient conversions to hepatectomy was seven for ACE and three for cTACE. In the tumor specimens, viable tumor was found in two of eight specimens that underwent ACE and three of three that underwent cTACE. Conclusion ACE is a feasible, safe, and well-tolerated treatment for patients with HCC; it is highly effective and may be more effective than cTACE in achieving CR. RSNA, 2017 Online supplemental material is available for this article.

Pickering emulsions with ethiodized oil and nanoparticles for slow release of intratumoral anti-CTLA4 immune checkpoint antibodies

“…Our delivery platform is based on ethiodized oil, which is already approved for a long time in clinical practice with various delivery routes such as intra-arterial, intralymphatic and remains used for hysterosalpingography. [34][35][36] In our in vivo experiment study, responses and survival rates offered by the intratumorous injection of the antibody alone and intratumorous injection of the Pickering emulsion were not significantly different. Beyond local efficacy on injected tumors, both anti-CTLA4 and PEEP-anti-CTLA4 conferred an in situ vaccine protection, demonstrated by the absence of tumor regrowth in mice rechallenged with the same tumor cell line.…”

The Hong Kong consensus statements on unresectable hepatocellular carcinoma: narrative review and update for 2021

“…An RCT evaluated TEA in comparison to TACE in 200 HCC patients and, although terminated early, interim analysis showed that while there was no significant difference in OS, TEA demonstrated better complete tumor response and longer PFS than TACE ( 64 ). A 2018 case-control study compared outcomes of ACE (study group) and TACE (control group) in 44 HCC patients, and median time to progression and median PFS were significantly longer in the study group than in the control group ( 65 ). The authors concluded ACE was safe and effective and may be more effective than TACE in achieving complete response ( 65 ).…”

“…A 2018 case-control study compared outcomes of ACE (study group) and TACE (control group) in 44 HCC patients, and median time to progression and median PFS were significantly longer in the study group than in the control group ( 65 ). The authors concluded ACE was safe and effective and may be more effective than TACE in achieving complete response ( 65 ). While TEA and ACE are probably more effective than TACE, a high level of clinician experience and careful patient selection is required for successful use of TEA and ACE.…”

Superselective ablative chemo-ethanol embolization for recurrent single hepatocellular carcinoma: a 6-month outcome analysis

“…The Recent Barcelona Clinic Liver Cancer (BCLC) guidelines justify the role of TACE for rHCCs 2 ; however, TACE has limitations such as washout of chemoemulsion or limited penetration to the tumor periphery due to the contribution of tumor blood flow by adjacent portal venules 10,11 . Therefore, superselective ablative chemoembolization (SACE) has emerged as a promising transarterial therapy that addresses the inherent limitations of TACE [10][11][12][13][14][15][16][17] . SACE offers a unique approach that exploits the cytotoxic effects of ethanol directly on tumor cells and the embolization effect by targeting both tumor-feeding arterioles and periportal venules, thereby circumventing the limitations observed with conventional TACE 14 .…”

“…Therefore, superselective ablative chemoembolization (SACE) has emerged as a promising transarterial therapy that addresses the inherent limitations of TACE [10][11][12][13][14][15][16][17] . SACE offers a unique approach that exploits the cytotoxic effects of ethanol directly on tumor cells and the embolization effect by targeting both tumor-feeding arterioles and periportal venules, thereby circumventing the limitations observed with conventional TACE 14 .…”