Adjuvant Medications That Improve Survival after Locoregional Therapy

Abstract

Purpose To determine if outpatient medications taken at the time of liver tumor embolization or ablation affect survival. Methods An IRB-approved retrospective review was performed of 2032 liver tumor embolization, radioembolization, and ablation procedures on 1092 patients from June 2009 to April 2016. For each patient, the following information was analyzed: pathology, hepatocellular carcinoma (HCC) stage (AJCC), neuroendocrine tumor (NET) grade, initial locoregional therapy, overall survival after initial locoregional therapy, Child Pugh score, ECOG performance status, Charlson comorbidity index, and outpatient medications taken at the time of locoregional therapy. Kaplan Meier survival curves were calculated for patients taking 29 medications or medication classes (including both prescription and non-prescription medications), which the patient was taking for reasons unrelated to their primary cancer diagnosis. Kaplan Meier curves were compared using the log-rank test. Results For HCC patients initially treated with embolization (n=304 patients), the following medications were associated with improved survival when taken at the time of embolization: beta blockers (p=0.0007), aspirin (p=0.0008) and other NSAIDs (p=0.009), proton pump inhibitors (p=0.004), and antivirals for HBV or HCV (p=0.01). For colorectal liver metastases initially treated with ablation (n=172 patients), beta blockers were associated with improved survival when taken at the time of ablation (p=0.02). For NET patients initially treated with embolization, and colorectal patients initially treated with radioembolization, there was no association between medications and survival. Conclusion Aspirin and beta blockers are associated with significantly improved survival when taken at the time of embolization for HCC. Aspirin was not associated with survival differences after locoregional therapy for NET or colorectal liver metastases, suggesting an HCC-specific effect.

Aspirin Is Associated With Improved Liver Function After Embolization of Hepatocellular Carcinoma

“…This HIPAA-compliant retrospective study received institutional review board approval. A previously reported retrospective review [2] had identified 304 consecutively registered patients with HCC (232 [76%] men, 72 [24%] women; mean age at embolization, 69 years) who were treated with TAE between June 2009 and April 2016. Further analysis of this group of patients was conducted in the current study.…”

“…Retrospective studies have shown that aspirin use is associated with improved survival when combined with transarterial chemoembolization [1] or transarterial embolization (TAE) [2] for hepatocellular carcinoma (HCC). Several theories have been proposed to explain these results [2]. First, aspirin is antiinflammatory.…”

Outcomes After Transarterial Embolization of Neuroendocrine Tumor Liver Metastases Using Spherical Particles of Different Sizes

“…Treatment toxicity could play a role, but in our study, there was no difference in complications between the two groups. Another possibility is that locoregional therapy can induce systemic effects that might counter the local benefits of the treatment [15]. One promising approach for improving survival (not just response) after locoregional therapy is the use of adjuvant medications that modulate these harmful systemic effects [15; 16].…”

Reply to: “Adjuvant Medications that Improve Survival after Locoregional Therapy”

“…We thank Dr. Jiang for the interest in our paper [1], where we showed that aspirin was associated with improved survival when taken at the time of initial embolization for HCC.…”

“…Starting HCC patients on aspirin 81 mg daily before TACE or TAE might be beneficial, based on the evidence presented in our paper [1], another retrospective study showing improved survival when combining aspirin and TACE for HCC [2], a retrospective study showing that aspirin reduces both the risk of developing HCC and the risk of death from chronic liver disease [3], and randomized trials showing that aspirin decreases the risk of death from various adenocarcinomas [4]. Caution should be exercised if the patient has peptic ulcer disease, high risk of bleeding, or another contraindication to aspirin.…”