Treatment Benefits and Side Effects of Transarterial Chemoembolization with Drug-Eluting Bead Microspheres (DEB-TACE) in Hepatocellular Carcinoma Patients with Conventional TACE Resistance: A Retrospective Study

Abstract

Background: Hepatocellular carcinoma (HCC) is currently the fourth most common malignant tumor and the second most fatal tumor in China, posing serious threats to the health and life of individuals. Objectives: This retrospective study aimed to investigate the treatment benefits and side effects of transarterial chemoembolization with drug-eluting bead microspheres (DEB-TACE) for HCC patients with conventional TACE (cTACE) resistance. Patients and Methods: A total of 17 HCC patients with cTACE resistance, treated by DEB-TACE, were retrospectively analyzed from July 2017 to December 2019. According to the modified response evaluation criteria in solid tumors (mRECIST), the efficacy of treatment was classified into complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD), and the objective remission rate (ORR) and the disease control rate (DCR) were also measured at 6 and 12 weeks post-DEB-TACE treatment. Changes in liver enzymes, routine blood tests, and alpha-fetoprotein (AFP) levels were also documented. Besides, the patients’ adverse reactions were observed within one week after surgery to assess the safety of DEB-TACE therapy. Results: In patients with cTACE resistance, the CR, PR, SD, PD, ORR, and DCR were 0, 35.29%, 47.06%, 17.65%, 35.29%, and 82.35% at six weeks after DEB-TACE and 5.88%, 47.06%, 29.41%, 17.65%, 52.94%, and 82.35% after 12 weeks, respectively. In the first week after DEB-TACE, the levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, and white blood cells elevated temporarily (P < 0.05), and side effects, such as slight pain, fever, nausea, and vomiting, occurred after surgery. Following liver protection and symptomatic treatment, the patients recovered well. Conclusion: Based on the results of this study, DEB-TACE has treatment benefits and few side effects for HCC patients with cTACE resistance.

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“…According to Rossi (2018), clinical experiments confirm a substantially lower serum concentrations and favourable intra-tumour chemotherapy after DEB-TACE compared with cTACE. Unlike lipiodol, DEB-TACE is better in regulating the occlusion level and antitumour drug releasing, which may ensure a prolonged and sustained medication delivery, besides a drug (Dox) high diffusion into the beads adjacent liver tissue (Wu et al, 2018;Zhao et al, 2020Zhao et al, , 2022Zhao et al, 2020Zhao et al, , 2022. After the third cycle, the most significant reported side effects in this study were the cardiovascular symptoms detected in 8 (20%) of the total number of patients.…”

“…The advantage of using BEADs over cTACE regarding toxicity in this study may be due to slow DOX release into systemic circulation. Generally, all chemotherapeutic drugs are deliberately released into the tumour at an uninterruptedly high concentration, that leads to synergistically blocked at the commencement of the treatment and at certain concentration, where the tumour cells are subjected to greater chemotherapeutic effects in comparison to the healthy perfusion (Zhao et al, 2022).…”

“…Furthermore, being a risk factor for HCC development, liver cirrhosis predisposes patients to portal hypertension (Lopez-Gomez et al, 2021). According to Zhao et al (2022), The Kaplan-Meier cumulative survival curve of the DEB-TACE group (22 months) was significantly longer than that of the cTACE group (17 months). Such findings were confirmed closely all subgroups of the current study population, may be correlated to the ability of DEB-TACE to spread further than cTACE into the sinusoids to the distal portal vein branches, passing through the pri-biliary plexus a transient dual embolization arterial as well as portals (Facciorusso, 2018).…”