Efficacy of transarterial chemoembolization monotherapy or combination conversion therapy in unresectable hepatocellular carcinoma: A systematic review and meta-analysis

Abstract

BackgroundHepatocellular carcinoma (HCC) is a highly malignant disease with poor prognosis, and most cases were already considered unresectable at the time of presentation. Conversion therapy, as an emerging treatment, is designed to provide patients with initially unresectable hepatocellular carcinoma (uHCC) the opportunity to undergo radical resection. At present, conversion therapy for patients with uHCC remains controversial. Transarterial chemoembolization (TACE) is currently the most widely selected treatment for uHCC, but its efficacy as a conversion therapy remains controversial.MethodsWe compared and evaluated the conversion rate for and tumor response to TACE monotherapy or combination therapy. Meanwhile, postoperative complications and overall survival (OS) in uHCC patients who underwent conversion therapy were also analyzed.ResultsA total of 18 studies were included in this meta-analysis. The conversion rate for triple therapy [TACE in combination with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs)] was 42% [95% confidence interval (CI), 0.29–0.56], higher than any other group [TACE monotherapy: 10% (95% CI, 0.08–0.12), bigeminy therapy: 19% (95% CI, 0.06–0.36)]. Meanwhile, triple therapy yielded a better tumor response than TACE monotherapy or bigeminy therapy. Among the patients with successful surgical resection after conversion therapy, the pooled postoperative OS rates at 1, 2, and 5 years were 90% (95% CI, 0.81–0.97), 58% (95% CI, 0.42–0.73), and 42% (95% CI, 0.26–0.60), respectively, and the major postoperative complications were biliary leakage (7%; 95% CI, 0.03–0.12) and liver failure (3%; 95% CI, 0.00–0.07).ConclusionTACE conversion therapies showed good conversion rates, especially the triple therapy of TACE in combination with TKIs and ICIs. Surgical resection after successful conversion therapy could maximize the outcome of patients with uHCC.

Combination treatment of transcatheter arterial chemoembolization, intensity-modulated radiotherapy, and sorafenib for hepatocellular carcinoma with macrovascular invasion

“…Consequently, systemic damage caused by radiation was limited and minimized. [31] Advanced HCC patients with MVI exhibited poor tumor biological behavior, a high risk of postoperative recurrence, and a low long-term survival rate. [32] Several studies have explored different treatment strategies for this patient group.…”

Therapeutic options in hepatocellular carcinoma: a comprehensive review

“…Studies by Zhan et al have provided evidence that the combined therapy of radioembolization and immunotherapy is significantly effective and safe in treating HCC patients [107]. A study conducted by Li et al showed that the combination of TACE and hepatic arterial infusion chemotherapy (HAIC) has a more advantageous progression-free survival (PFS) due to its significantly higher conversion rate compared to conventional TACE (48% vs. 9%, respectively) [108]. Additionally, the administration of trans-arterial chemoembolization (TACE) followed by sorafenib treatment is found to be therapeutically effective in treating advanced HCC.…”

Conversion therapy for initially unresectable hepatocellular carcinoma: Current status and prospects

“…The use of TACE, TKIs, and ICIs has been found to increase residual liver volume in patients with intermediate to advanced HCC, thereby enhancing the safety of conversion resection (76). A meta-analysis of 18 studies found that the conversion rate of triple therapy (TACE+TKIs+ICIs) was 42%, which was higher than that of TACE alone (10%) and TACE combined with other therapies (19%) (77). The tumor response to triple therapy was superior to that of TACE alone or dual therapy (77).…”