Conventional versus drug-eluting beads chemoembolization for infiltrative hepatocellular carcinoma: a comparison of efficacy and safety

Abstract

BackgroundTo compare the efficacy and safety between conventional transarterial chemoembolization (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with infiltrative hepatocellular carcinoma (iHCC).MethodsA total of 89 iHCC patients who were treated with either cTACE (n = 33) or DEB-TACE (n = 56) between April 2013 and September 2017 were included in this retrospective study. Patients with the situations that might have a poor outcome were defined as advanced disease including Child-Pugh class B, bilobar lesions, tumor size greater than 10 cm, ECOG 1–2, tumor burden of 50–70%, and the presence of ascites, arterioportal shunt (APS), and portal venous tumor thrombus (PVTT). The tumor response was measured 1-month and 3-month after the procedure. Progression-free survival (PFS) was calculated. Toxicity was graded by Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0). The differences in tumor response, PFS, and toxicity were compared between the DEB-TACE group and cTACE group.ResultsAt 1-month and 3-month after the procedure, the objective response rate (ORR) in the overall study population was similar in DEB-TACE group and cTACE group. The disease control rate (DCR), at 1-month after the procedure, was significantly higher in the patients treated with DEB-TACE relative to those treated with cTACE (P = 0.034), while after 3 months, the difference did not differ between two groups. DEB-TACE showed a higher DCR than cTACE in patients with tumor size greater than 10 cm (P = 0.036) or associated with APS (P = 0.030) at 1-month after the procedure, while after 3 months, the difference was only noted in patients with APS (P = 0.036). The median PFS in DEB-TACE group was 96 days, while in cTACE group was 94 days, and there was no difference in PFS between two groups (P = 0.831). In the side effect analysis, abdominal pain (P = 0.034) and fever (P = 0.009) were more frequently present in the cTACE group than DEB-TACE group, but there was no difference in high grade liver toxicity between the two groups.ConclusionsCompared to cTACE, DEB-TACE offers slightly better DCR and tolerability for iHCC patients, particularly in patients associated with APS and large tumor size. However, DEB-TACE does not provide higher PFS than cTACE.

A Comparison of Adverse Events Among Radiofrequency Ablation, Conventional Transarterial Chemoembolization (TACE) and Drug-Eluting Bead TACE in Treating Hepatocellular Carcinoma Patients

“…In regard to probable explanations, we speculated that the result of total AEs incidence being the highest in cTACE group may be related to the technical process of cTACE, including the application of lipiodol and large size embolization particles, which could both contribute to a higher AEs incidence. 21 , 26 Furthermore, we also found a difference in incidence of fever, fatigue, and nausea among the three therapies, and to be specific, the incidences of fever, fatigue, and nausea were increased in cTACE group compared to RFA group, fever incidence was increased in DEB-TACE group in comparison to RFA group, and fatigue incidence was elevated in cTACE group compared to DEB-TACE group. These findings indicated that RFA was superior to cTACE and DEB-TACE in HCC patients regarding fever, fatigue, and nausea incidences, which could provide some information when it comes to decision-making in the management of HCC patients.…”

“…Moreover, we also observed that cTACE was independently correlated with increased risk of total AEs, fatigue, and nausea/vomiting, this could result from the features of cTACE treatment involving the use of lipiodol and large size embolization particles, as explained previously. 21,26 Moreover, we also found that male gender, bronchial asthma, heart disease, diabetes mellitus, disease duration, blood supply of tumor, ablation history, TACE history, radioactive seeds implantation history, TBIL level, ALT level, and complete embolization/ablation were also independent predictive factors for total AEs or specific AEs. These probably could provide more information on the management of HCC patients regarding choosing the optimal therapy to maximize the elimination of AEs.…”

“…20 And for cTACE, a previous retrospective cohort study illuminated that in infiltrative HCC patients treated with cTACE, majority of the AEs were mild (clinical grade 1-2), and the AEs at advanced clinical grade merely occurred in a small proportion of patients, such as hepatic bleeding (6.1%) and GI bleeding (3.0%). 21 As for DEB-TACE in HCC patients, a retrospective cohort study reported that in HCC patients who received DEB-TACE, the liver function assessed by laboratory indexes deteriorated in a transient period of less than 3 months, and majority of the AEs were considered as embolization syndrome, which is manageable after supportive care. 22 To the best of our knowledge, no study has been performed to assess the difference in AEs among RFA, cTACE, and DEB-TACE in HCC patients, however, there are mounting studies that have compared two modalities.…”

Tumor Growth Suppression With Novel Intra-arterial Chemotherapy Using Epirubicin-entrapped Water-in-oil-in-water EmulsionIn Vivo

“…If IPSO microdroplets are too small for the inner diameter of the tumor vasculature, they may pass through the tumor tissues and normal tissues; if the microdroplets are too large, they are trapped proximal to the tumor vasculature (15,16). Drug-eluting beads (DEBs) have been developed for transcatheter treatment of HCC because DEBs can deliver higher dose of the anticancer agents and prolong the contact time with the tumor (17)(18)(19)(20)(21). Treatment with DEBs reduces the amount of anticancer agent reaching the systemic circulation (18).…”

Current updates in machine learning in the prediction of therapeutic outcome of hepatocellular carcinoma: what should we know?

“…Most HCC patients are typically diagnosed at intermediate or advanced stages when curative treatments cannot be applied [ 71 , 72 ]. According to the Barcelona Clinic Liver Cancer (BCLC) staging system [ 73 ] and several treatment guidelines [ 6 , 7 ], TACE is the gold standard for patients with intermediate-stage HCC.…”