Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

Abstract

Background & aimIn clinical practice, transarterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma (HCC) beyond as well as within guideline recommendations. Here we aimed to verify whether two consecutive non-responses could be an optimal criterion for creating a rule to stop TACE being performed on these patients. MethodsThis study evaluated 200 patients with HCC beyond the Milan criteria, initially treated with TACE. TACE response was determined using the mRECIST criteria via dynamic CT or MRI. Median follow-up duration was 23.9 months. ResultsWithin the 200 patients analyzed, 183 (91.5%) were male, with a total median age of 59.8 years. The mean size of the largest tumor was 6.8 cm, with 80 (40.0%) patients with �4 tumors. After the first TACE procedure, complete response, partial response, stable disease, or progressive disease were observed in 48 (24.0%), 87 (43.5%), 59 (29.5%) and 6 (3.0%) of patients, respectively. 45 (22.5%) patients showed no objective response (OR) following two consecutive TACE sessions. Of these, 28 received a subsequent TACE, with a 10.7% OR rate. Patients without OR showed poorer survival when compared to patients who achieved OR after repeated TACE. Multivariable analysis showed that size of the largest tumor >5cm and high alpha-fetoprotein of >200 ng/mL were significant factors associated with failure of OR to two consecutive TACE sessions. ConclusionPatients showing no OR to two consecutive TACE sessions will present a poor OR to subsequent TACE procedures. Early transition to systemic therapy may be advocated in such cases. PLOS ONEPLOS ONE | https://doi.org/10.

<p>Relevance of EGFR Between Serum VEGF and MMP-9 in Primary Hepatocellular Carcinoma Patients with Transarterial Chemoembolization</p>

“…35 Therefore, several researchers attempted to clarify whether two consecutive nonresponses are the optimal criteria for the introduction of a guideline to stop further TACE therapy for patients with HCC by evaluating their response to TACE. 36 Evidence has confirmed the indispensable role for EGFR in LC, 2 thereby indicating that targeted EGRF might be a useful marker and could represent a new therapeutic target for EGFR-positive patients with HCC. Tumorigenesis is linked with macrophage-mediated chronic inflammation and various signaling pathways, including EGFR pathway.…”

Initial treatment response to transarterial chemoembolization as a predictive factor for Child–Pugh class deterioration prior to refractoriness in hepatocellular carcinoma

“…According to several previous studies, the response assessment after initial TACE could be a significant surrogate marker for accurate prognostication in patients with repeated TACE. [27][28][29][30][31] In addition, the Assessment for Retreatment with TACE (ART) score, which is a scoring system including tumor response to initial TACE, was proposed to aid in selecting retreatment strategies. [32][33][34] The ART score is useful to identify patients who would not benefit from additional TACE and who should be converted to systemic therapy.…”

“…We assessed the significance of the radiological response to initial TACE as a predictor associated with Child–Pugh class deterioration prior to TACE refractoriness. According to several previous studies, the response assessment after initial TACE could be a significant surrogate marker for accurate prognostication in patients with repeated TACE 27–31 . In addition, the Assessment for Retreatment with TACE (ART) score, which is a scoring system including tumor response to initial TACE, was proposed to aid in selecting retreatment strategies 32–34 .…”

Report from the Western Canadian Gastrointestinal Cancer Consensus Conference Virtual Education Series—Transition from Local to System Therapy and Optimal Sequencing of Systemic Therapy for HCC

“…Although there has been general agreement that TACE refractoriness should be an indication for the transition to systemic therapy, a definition of TACE refractoriness was elusive for a number of years. Choi et al studied 200 patients with HCC beyond the Milan criteria for liver transplantation [ 25 ]. About one-quarter of patients showed no objective response following two TACE sessions.…”