mRECIST and EASL responses at early time point by contrast-enhanced dynamic MRI predict survival in patients with unresectable hepatocellular carcinoma (HCC) treated by doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE)

Abstract

EASL and mRECIST responses measured on MRI at an early time point after DEB TACE predicted survival. mRECIST response demonstrated higher survival correlation than EASL.

New Data Supporting Modified RECIST (mRECIST) for Hepatocellular Carcinoma

“…The study confirms the results of several recent investigations conducted in the United States, Europe, and Asia (3)(4)(5).…”

“…Several clinical trials from investigators around the globe have suggested that this is indeed the case in patients receiving tumor-directed therapies (1,(3)(4)(5). In patients treated with TACE, mRE-CIST ORR of 32% to 57% were observed, with significant correlation between response and overall survival (3,5). Data in patients treated with molecular targeted agents are still limited.…”

Immediate post‐doxorubicin drug‐eluting beads chemoembolization Mr Apparent diffusion coefficient quantification predicts response in unresectable hepatocellular carcinoma: A pilot study

“…2,4,9,12,17 Although poor correlation was demonstrated between survival and tumor response when using WHO and RECIST criteria, mRECIST and EASL have been found to be independent predictors of survival at 1 month posttherapy. [18][19][20] Using enhancement pattern and size changes, the currently known earliest time for reliable objective assessment of HCC response to cTACE or DEB-TACE is 30 to 90 days, as early gadolinium-enhanced contrast magnetic resonance imaging (MRI) may not discern residual tumor from therapy-induced inflammatory changes. 2,19,21 Early assessment of objective response HCC to DEB-TACE is crucial for a robust and individualized therapeutic plan, since not all HCC patients may respond to DEB-TACE, and early knowledge of lack of response would consequently allow treating physicians to offer alternative therapeutic approaches, such as radioembolization or systemic therapy.…”

“…[18][19][20] Using enhancement pattern and size changes, the currently known earliest time for reliable objective assessment of HCC response to cTACE or DEB-TACE is 30 to 90 days, as early gadolinium-enhanced contrast magnetic resonance imaging (MRI) may not discern residual tumor from therapy-induced inflammatory changes. 2,19,21 Early assessment of objective response HCC to DEB-TACE is crucial for a robust and individualized therapeutic plan, since not all HCC patients may respond to DEB-TACE, and early knowledge of lack of response would consequently allow treating physicians to offer alternative therapeutic approaches, such as radioembolization or systemic therapy. 22,23 Conversely, patients who exhibit early partial response to DEB-TACE, which may not be accurately evaluated based on size and enhancement pattern changes, may benefit from staged DEB-TACE.…”

Advances in endovascular therapy to treat primary hepatocellular carcinoma

“…PRECISION V, a phase IV trial of 212 patients with HCC (12), has indicated that the use of microspheres results in a higher rate of tumor necrosis at 6 months but no significant difference in the overall survival rate (51.6% vs. 43.5%). Research has shown that drugloaded microspheres are effective in the short term, they are better tolerated, and they significantly decrease the incidence of severe hepatotoxicity events.…”