Indication of suitable transarterial chemoembolization and multikinase inhibitors for intermediate stage hepatocellular carcinoma

Abstract

Prognosis of patients with intermediate stage hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE) is unsatisfactory. The present study analyzed the indications for suitable TACE in patients with intermediate stage HCC. Additionally, it was investigated whether further TACE or switching to multi-kinase inhibitors (MKIs) was more beneficial for patients with HCC recurrence following initial TACE. The present retrospective study included 238 patients with intermediate stage HCC who were initially treated with TACE (median age, 74 years). A decision-tree analysis was employed to investigate the therapeutic effect profiles and overall survival (OS) rates. In the decision-tree analysis for OS, complete response (CR) by initial TACE was selected as the most important variable. In the decision-tree analysis for CR, <3 liver segments with nodule, simple nodular type and within the up-to-seven criteria were selected as the first, second and third variables associated with a high CR rate (35-64%), respectively. In patients with HCC recurrence having ≥3 liver segments with nodule, out of the up-to-seven criteria, and Child-Pugh class A, the median survival time was significantly longer in those who were treated by switching to MKIs compared with further TACE (44.9 vs. 21.9 months; P=0.003). In intermediate stage HCC, the indications for suitable TACE criteria may be '<3 liver segments with nodule', 'simple nodular type', and 'within the up-to-seven criteria'. Additionally, in patients who were ineligible for TACE criteria, the switch to MKIs may improve the prognosis compared with further TACE in cases of HCC recurrence following first TACE.

Clinical Significance of Adverse Events for Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Retrospective Study

“…We also performed a decision tree analysis to identify factors associated with discontinuation due to AEs, as previously described [51]. To select the factors for multivariate analysis, a stepwise procedure was employed as previously described [52,53]. A two-tailed p -value of < 0.05 was considered statistically significant.…”

Alternating Lenvatinib and Trans-Arterial Therapy Prolongs Overall Survival in Patients with Inter-Mediate Stage HepatoCellular Carcinoma: A Propensity Score Matching Study

“…The catheter was advanced toward the tumor-feeding artery. Conventional TACE was performed using 20–50 mg of epirubicin (Nippon Kaasku Co., Ltd., Tokyo, Japan) or cisplatin (Nippon Kayaku Co., Ltd) with lipiodol (Guerbet Co., Ltd., Tokyo, Japan), depending on the size and number of tumors, and was absorbable gelatin sponge particles (Nippon Kayaku Co., Ltd.) [ 5 ]…”

“…Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Although the prognosis of patients with early-stage HCC has been improved by the development of curative therapies [ 3 , 4 ], patients with advanced HCC are usually treated with transcatheter arterial chemoembolization (TACE) [ 5 , 6 ], hepatic arterial infusion chemotherapy (HAIC) [ 7 ], molecular-targeted agents (MTAs) [ 3 ], and immunotherapy [ 8 ] and the prognosis remains poor.…”

Association between contrast enhancement on contrast‑enhanced CT and lenvatinib effectiveness in hepatocellular carcinoma

“…The catheter was advanced towards the tumour-feeding artery. Depending on the size and number of tumours, conventional TACE (C-TACE) was performed using 20-50 mg of epirubicin (Nippon Kayaku Co., Ltd.) or cisplatin (Nippon Kayaku Co., Ltd.) with lipiodol (Guerbet Co., Ltd.), and was absorbed by gelatin sponge particles (Nippon Kayaku Co., Ltd.) ( 13 , 14 ).…”