Systematic review comparing the safety and efficacy of conventional and drug‐eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma

Abstract

Aim: Conventional transarterial chemoembolization (cTACE)is widely used for treating patients with inoperable hepatocellular carcinoma (HCC). A variation on the technique based on drug-eluting beads (DEB-TACE) has recently entered the clinic, but trials of its safety and efficacy have given conflicting results. This systematic review aimed to gain a current, comprehensive picture of how DEB-TACE compares with cTACE.Methods: MEDLINE, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure database and clinical trial registries were searched through June 2014. Risk ratios (RR), hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Results:The analysis included four randomized controlled trials, one uncontrolled prospective study and one prospective case-control study, altogether involving 652 patients. Overall survival benefit was similar between cTACE and DEB-TACE patients (HR = 1.07, 95% CI = 0.82-1.40, P = 0.875). However, DEB-TACE was associated with a significantly higher objective tumor response rate (RR = 1.14, 95% CI = 1.01-1.29, P = 0.03) and a slightly lower incidence of adverse events. Conclusion:Though the available evidence suggests that although DEB-TACE is associated with better tumor response and potentially fewer adverse events, it does not provide greater survival benefit than cTACE. These results need to be validated in high-quality trials with large sample size.

Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma?

“…DEB-TACE has been shown to be safe and effective in palliative HCC treatment in several clinical and preclinical studies (27,(36)(37)(38)(39)(40)(41), as well as in a randomized clinical trial (RCT) comparing DEB-TACE with cTACE (23,26), but the evidence to support its use as a neoadjuvant treatment before OLT is scarce (25,(42)(43)(44)(45)(46). To our knowledge, this is the first clinical study that compares OS and DFS of patients that did and did not receive DEB-TACE before OLT and one of the largest series assessing neoadjuvant DEB-TACE clinical results in the literature so far.…”

Drug‐eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma

“…9 Moreover, a recent systematic review collecting all the available data on the comparison between the two treatment regimens confirmed the non-superiority of one technique over the other in terms of OS (primary endpoint) and safety profile. 18 The sole result significantly in favor of DEB-TACE was the higher objective response rate (ORR), but this finding was mainly due to a single outlier retrospective Korean report. 7 In the present study, we compared the efficacy of DEB-TACE and cTACE in two consecutive cohorts of patients, which, to the best of our knowledge, represent the largest mono-institutional series of HCCs treated with TACE as elective treatment in the West.…”

Use of Initial Modified RECIST Tumor Response Evaluation Criteria for Predicting Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization with Drug-Eluting Beads

“…However, there are conflicting results regarding the relative effects of TACE-DEB and conventional TACE on overall survival [8] [9]. Huang et al performed a meta-analysis including seven studies and 700 patients and demonstrated that 1-year and 2-year survival rates were better after TACE-DEB compared with conventional TACE [8].…”

“…Huang et al performed a meta-analysis including seven studies and 700 patients and demonstrated that 1-year and 2-year survival rates were better after TACE-DEB compared with conventional TACE [8]. In contrast, a recent systematic review demonstrated that, although TACE-DEB was associated with better tumor response and potentially fewer adverse events, it did not confer a greater survival benefit compared with conventional TACE [9].…”