Chemoembolization of unresectable hepatocellular carcinoma: Decreased toxicity with slow-release doxorubicin‑eluting beads compared with lipiodol

Abstract

Abstract. Chemoembolization with lipiodol (TACE) improves survival of selected patients with unresectable hepatocellular carcinoma (HCC), but results in substantial toxicity. To improve treatment tolerance, we conducted this phase II study using doxorubicin-loaded beads (DC Beads ® ) delivered by selective transcatheter arterial chemoembolization (DEB-TACE). We compared the results with those obtained with TACE in our historical controls. Thirty-five patients were recruited with diagnoses of HCC. Patients received DEB-TACE with doxorubicin loaded on DC Beads. Computed tomography of the upper abdomen was performed one month after DEB-TACE. Historical controls were a group of 70 patients with matched characteristics treated with TACE. After a median follow-up of 14.1 months (range, 6-36 months), 22 patients (63%) had an objective response. There was a statistically significant decrease in liver enzymes (P<0.001), lactate dehydrogenase, (P<0.001) in DEB-TACE-treated patients compared to TACE-treated patients. DEB-TACE with doxorubicin-loaded DC Beads, a safe and reliable treatment for HCC, leads to decreased toxicity compared to TACE.

Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…Two articles [18,38], which were written by the same author, failed to provide data related to patient affiliation with the same group, and therefore, were also considered as one study [18]. Finally, 16 studies [20,22,29,39], 3 prospective cohorts [21,40,41], 9 retrospective cohorts [16][17][18][19]23,30,[42][43][44]). The quality scores of the four RCTs assessed by JADAD scale are 4 [20,22,39] and 5 [29].…”

“…The quality scores of the four RCTs assessed by JADAD scale are 4 [20,22,39] and 5 [29]. The quality scores of the twelve cohort studies were assessed by Newcastle-Ottawa scale rang from 6 to 9 stars, in which three 6 [30,41,42], five are 7 [17,19,40,43,44], three are 8 [16,21,23] and one is 9 [18] stars.…”

“…Four retrospective studies [16][17][18][19] have suggested the significant superiority of DEB-TACE in terms of overall survival (OS) or tumor response or less adverse events. However, a few studies [20][21][22][23] suggested that the two modalities were equally effective and safe. Meta-analyses to select a better TACE yielded different results [24][25][26][27][28].…”

“…By contrast, Dhanasekaran et al [16] concluded that in both BCLC A and B HCC, the OS rate was significantly higher in the DEB-TACE group compared with the cTACE group. However, there was no previous meta-analysis conducted; • to our knowledge, four studies reported relapse-free survival (RFS) with different results [18,20,21,30].…”

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

“…It has been demonstrated to have a lower toxicity profile compared to cTACE [79] . However, studies so far failed to prove its ability to consistently prolong survival [79][80][81][82][83][84] . Moreover, as a relatively new agent, only a paucity of studies has looked at its effect on high-burden HCC, particularly those with portal vein invasion.…”