Survival, tumour response and safety of 70‐150 μm versus 100‐300 μm doxorubicin drug‐eluting beads in transarterial chemoembolisation for hepatocellular carcinoma

Abstract

Introduction This study investigates the outcomes and safety of 70–150 μm and 100–300 μm doxorubicin drug‐eluting bead transarterial chemoembolisation (DEB‐TACE) in patients with unresectable hepatocellular carcinoma (HCC). Methods Retrospective, cohort study of 51 patients treated with DEB‐TACE for unresectable HCC was studied: 23 with 100–300 μm particles and 28 with 70–150 μm particles. Overall, survival (OS), progression‐free survival (PFS), tumour response and prognostic factors were assessed. Results The median OS of the entire cohort was 30 months. The median OS and median PFS for 70–150 μm particles were not reached, whilst for the 100–300 μm group, it was 29.2 months and 15.0 months, respectively. The 6‐month, 1‐year and 2‐year OS for 70–150 μm was 96%, 86% and 85% versus the 100–300 μm particles size of 83%, 64% and 44%, respectively. At 1‐month follow‐up, patients treated with 70–150 μm had significantly better mRECIST tumour response compared to 100–300 μm (complete response 38.5% vs. 19%; partial response 57.7% vs. 42.9%; stable disease 0% vs. 4.8%; progressive disease 3.8% vs. 33.3%, P = 0.027). Patients treated with 100–300 μm DEBs were significantly more likely to have progressive disease on 1‐month follow‐up imaging compared those treated with 70–150 μm DEB sizes (odds ratio 7.15, P = 0.007). The 30‐day mortality rate was similar between the two groups (3.6% for 70–150 μm vs. 4.3% for 100–300 μm). Multivariate analysis demonstrated entire cohort OS was significantly associated with BCLC stage (aHR: 10.5, P = 0.002), albumin (aHR: 15.0, P = 0.02) and ALP (aHR 62, P = 0.001). Conclusions DEB‐TACE with 70–150 μm particles demonstrates improved 1‐month objective tumour response compared to 100–300 μm, whilst having a similar safety profile. Elevated ALP, lower albumin and higher BCLC stage were significantly associated with poorer survival outcomes.

Safety and effectiveness of new embolization microspheres SCBRM for intermediate-stage hepatocellular carcinoma: A feasibility study

“…Recent studies have shown that patients with HCC receiving smaller microspheres showed better tumor response, better survival outcomes, fewer adverse events, and fewer patient complications [ 32 , 33 ]. However, using microspheres that are too small may lead to worse results.…”

Transarterial chemoembolization with medium-sized doxorubicin-eluting Callisphere is safe and effective for patients with hepatocellular carcinoma

“…This theory was supported by a recent study in patients with liver malignancies in whom DEBs with small diameters achieved improved the radiological response in terms of extensive intratumoral necrosis 12 . DEB-TACE with 70-150 µm particles demonstrated an improved 1-month objective tumor response compared to that with 100-300 µm particles in patients with HCC, while having a similar safety profile 13 .…”

Nanotechnology for Hepatocellular Carcinoma: From Surveillance, Diagnosis to Management

“…Transcatheter arterial chemoembolization (TACE) is currently used as a first‐line therapy for BCLC B stage unresectable HCC. [ 97–99 ] In fact, TACE is the loco‐regional treatment to selectively block tumoral blood supply partially or more completely. [ 100 ] Using a microcatheter, chemotherapeutics with the drug encapsulated are infused followed by the embolic agent clinically, which provides theoretical support for improving the efficiency of perfusion chemotherapy with nanotechnology.…”