The impact of antiangiogenic therapy combined with Transarterial Chemoembolization on enhancement based quantitative tumor response assessment in patients with hepatocellular carcinoma

Abstract

Purpose To investigate whether Bevacizumab compromises early response assessment after Transarterial Chemoembolization (TACE) in patients with hepatocellular carcinoma by 3D quantitative European Association for the Study of the Liver (qEASL) criteria in comparison to other imaging-based criteria. Materials and Methods Each of 14 patients receiving TACE and bevacizumab was matched with two patients receiving TACE alone. Baseline and Follow-up MRI was retrospectively analyzed regarding qEASL and other imaging-based criteria. Results Percentage-based qEASL achieved significant separation in both therapy arms (p=0.046 and p=0.015). Response and Overall Survival showed similar association among treatment groups (p=0.749). Conclusions Anti-angiogenic therapy with bevacizumab does not impede early response assessment by qEASL.

Validation of the easy‐to‐use lenvatinib prognostic index to predict prognosis in advanced hepatocellular carcinoma patients treated with lenvatinib

“…Starting from promising preclinical evidence, 28,29 several trials focusing on the combination of TACE and TKIs have been conducted with heterogeneous results 30–36 . Interestingly, the results from the phase III multicenter randomized controlled combination LAUNCH trial have recently been presented at ASCO 2022, thus highlighting a survival benefit from TACE plus lenvatinib when compared with lenvatinib alone in a cohort of patients affected by advanced HCC with good liver function (mOS 17.8 vs. 11.5 months) 35 .…”

“…Starting from promising preclinical evidence, 28,29 several trials focusing on the combination of TACE and TKIs have been conducted…”

Role of locoregional therapies in the wake of systemic therapy

“…48 In a study comparing TACE + bevacizumab to TACE alone, Smolka et al reported that bevacizumab did not impede response to TACE assessed by the quantitative EASL system for evaluation of local response (qEASL). 49 Given the hypothetical risk of anti-angiogenic drugs altering the tumour vasculature, which may impact negatively on the delivery of TACE this is reassuring, while the combination of TACE with anti-angiogenic drugs has been disappointing in terms of survival outcomes, there are encouraging data for the combination of bevacizumab with the T cell checkpoint inhibitor, atezolizumab (and indeed for other CPIs in combination with VEGFR tyrosine kinase inhibitors, e.g. lenvatinib with pembrolizumab) and such drug combinations may be tested in combination with TACE in future trials.…”

“…lenvatinib with pembrolizumab) and such drug combinations may be tested in combination with TACE in future trials. 49 Given the potential safety signals, scheduling of bevacizumab in relation to TACE requires caution.…”