A survey on transarterial chemoembolization refractoriness and a real-world treatment pattern for hepatocellular carcinoma in Korea

Abstract

Background/Aims: Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC), but there is much controversy about TACE refractoriness. The aim of this study was to identify trends in the actual clinical application of TACE and recognition of TACE refractoriness by Korean experts. Methods: In total, 17 questionnaires on TACE refractoriness were administered to 161 clinicians via an online survey. Multiple answers were allowed for some questions. Results: Most clinicians agreed that there is a need for standardization of TACE application through specific scoring systems (n=124, 77.0%). TACE refractoriness was predominantly expected by participants when recurrences were detected within 1 month (n=70, 43.5%), there were 4 to 6 tumors (n=77, 47.8%), the maximal tumor size was 3-5 cm (n=49, 30.4%), and when there was insufficient tumor necrosis despite TACE being repeated more than three times (n=78, 48.4%). Overall, sorafenib therapy (n=137) and radiotherapy (n=114) were preferred when repeated TACE was considered ineffective. Conclusions: Treatment of HCC is often based on the clinical judgment of clinicians because of the heterogeneity among individuals. Experts need to continue discussions on the standardization and sub-classification of HCC treatment guidelines in Korea.

Effectiveness of nivolumab versus regorafenib in hepatocellular carcinoma patients who failed sorafenib treatment

“…Despite the unsatisfactory effects, it is noteworthy that small portion of patients did achieve prolonged DOR more than a year and even complete responses with regorafenib or nivolumab treatment. HCC patients who experienced sorafenib failure are heterogenous in terms of varying prior treatments, 29 different tumor characteristics, and degrees of liver fibrosis, but biomarker based treatment is limited due to the risk of liver biopsy. Thus, treatment strategy of those patients is mainly dependent on clinical judgment.…”

A Real-World Comparative Analysis of Lenvatinib and Sorafenib as a Salvage Therapy for Transarterial Treatments in Unresectable HCC

“…Between January 2019 and September 2020, all patients diagnosed with histologically or clinically confirmed unresectable HCC (uHCC) according to the latest international guidelines who received lenvatinib or sorafenib treatment after the failure of transarterial treatments were retrospectively analyzed [ 3 , 21 , 22 ]. In the present study, we defined cases as “TACE-refractory cases” if any of the following conditions were met: (1) Insufficient necrotic area or an increase in viable tumor size after ≥2 consecutive TACE treatments; (2) increase in the tumor number or the development of new lesions during or within a few weeks of the TACE sessions; (3) persistent elevated levels of tumor markers after TACE; and (4) new development of vascular invasion or extrahepatic spread during or within a few weeks of the TACE sessions [ 23 , 24 ]. Since there is no precise definition for “HAIC refractory”, we defined it to be ‘showing more than 20% increase in the maximal diameter of the tumor (whether the tumor is hypervascular or infiltrative) or appearance of new intrahepatic or extrahepatic lesions after HAIC [ 25 ].…”

Prognostic Value of Alpha-Fetoprotein in Patients Who Achieve a Complete Response to Transarterial Chemoembolization for Hepatocellular Carcinoma

“…For patients with elevated AFP or poor AFP response after CR, surveillance using MRI, 37 scheduled secondary angiography, 10 and additional therapy, such as ablation or stereotactic radiotherapy, might be helpful for early detection of hidden lesions. 38 39 …”