In the Era of Systemic Therapy for Hepatocellular Carcinoma Is Transarterial Chemoembolization Still a Card to Play?

Abstract

Conventional transarterial embolization (cTACE) has been proven to be effective for intermediate stage hepatocellular carcinoma (HCC), with a recent systematic review showing an overall survival (OS) of 19.4 months. Nevertheless, due to the rapid development of the systemic therapeutic landscape, the place of TACE is becoming questionable. Is there still a niche for TACE in the era of immunotherapy and combination treatments such as atezolizumab–bevacizumab, which has shown an OS of 19.2 months with excellent tolerance? The development of drug-eluting microspheres (DEMs) has led to the standardization of the technique, and along with adequate selection, it showed an OS of 48 months in a retrospective study. In order to increase treatment selectivity, new catheters have also been added to the TACE arsenal as well as the use of cone-beam CT (CBCT), which provides three-dimensional volumetric images and guidance during procedures. Moreover, the TACE indications have also widened. It may serve as a “bridging therapy” for liver transplantation candidates while they are on the waiting list, and it represents a valuable downstaging tool to transplantation criteria. The aim of this review is to explore the current data on the advancements of TACE and its future place amongst the growing panel of treatments.

Intraarterial Therapies for the Management of Hepatocellular Carcinoma

“…Others include immunotherapeutic agents such as ipilimumab, nivolumab, and pembrolizumab [ 235 , 236 , 237 ]. A majority of the studies have shown positive results, with improved outcomes and acceptable safety profiles [ 238 ].…”

Long-term survival outcomes of drug-eluting bead transarterial chemoembolization in patients with hepatocellular carcinoma in Vietnam

“…Recently, the Up-to-seven criteria, which the total number of tumors and the largest tumor size (measured in cm) does not exceed 7, was introduced among HCC BCLC stage B [6]. Up to now, strategy of treatment of HCC stage B has changed quickly, however there is currently no speci c optimal treatment method [7].…”

“…Transarterial chemoembolization (TACE) is the most widely used treatment method for intermediatestage hepatocellular carcinoma (HCC) that is not suitable for curative treatment, and it is the rst choice for patients in the BCLC stage B subgroup [4,7]. TACE includes traditional lipiodol-based TACE and drugeluting bead TACE (DEB-TACE).…”