Transarterial chemoembolization for hepatocellular carcinoma: an evidence-based review of its place in therapy

Abstract

Transarterial chemoembolization (TACE) is the standard treatment for patients with Barcelona Clinic Liver Cancer-intermediate stage hepatocellular carcinoma (HCC). The concept of drug-eluting bead TACE builds on the rationale of intratumoral drug delivery, and drug-eluting bead TACE has been shown to provide consistent and reliable results and to significantly diminish systemic drug exposure, liver toxicity, and drug-related adverse events as compared with conventional TACE. Based on the belief that combinations of TACE and other local or systemic therapies have several theoretical advantages, many clinical trials have been conducted to evaluate the effectiveness of TACE in combination with local treatment such as radiofrequency ablation or radiotherapy, and systemic therapy such as sorafenib or another molecular therapy. TACE has also been used as a preoperative adjuvant chemotherapy in patients with HCC to improve survival and as a bridging therapy before liver transplantation to downstage HCC. In the present evidence-based review, the authors summarize the current status of these transcatheter arterial embolic therapies in HCC.

Evaluation of the Therapeutic Effect of Adjuvant Transcatheter Arterial Chemoembolization Based on Ki67 After Hepatocellular Carcinoma Surgery

“…This may be related to the activation of related signaling pathways after embolization and the induction of neoangiogenesis, forming a microenvironment conducive to tumor proliferation (25). In addition, the serum concentrations of vascular endothelial and fibroblast growth factors increase after TACE, and the serum levels are positively correlated with tumor progression (26). Tumor cells with low Ki67 expression are less sensitive to chemotherapeutic drugs, and the therapeutic effect of the drugs is less than the proliferation induced by hypoxia.…”

Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit

“…These clinicians reported that the efficacy of mTACE in patients with HCC is better than that of conventional TACE. [ 109 – 111 ]…”

Arsenic trioxide-loaded CalliSpheres: In vitro study of drug release and antitumor activity, and in vivo study of pharmacokinetics, treatment efficacy and safety in liver cancer

“…Transcatheter arterial chemoembolization (TACE) is a locoregional therapy that not only blocks the tumor blood supply through the use of an embolization agent but also infiltrates the tumor tissue resulting in a high concentration of the chemotherapeutic agent specifically within the tumor tissue. TACE is widely utilized to treat patients with unresectable liver cancer due to its favorable efficacy and tolerable side effects ( 4 ). Traditionally, the drug carriers in conventional TACE (cTACE) consist of lipiodol, a gelatin sponge, particles and other compounds, which fail to stably release chemotherapeutic agents and embolize target arteries accurately and completely ( 5 ).…”