DEB-TACE combined with hepatic artery infusion chemotherapy might be an affordable treatment option for advanced stage of HCC

Abstract

Alternative treatment modalities are necessary because of the low response rates and unsuitability of molecular-targeted agents (MTA) and/or immune checkpoint inhibitors (iCIs) in HCC patients. Therefore, we analyzed whether drug-eluting beads (DEB)-transcatheter arterial chemoembolization (TACE) with low-dose-FP (Ultra-FP) therapy could improve the efficacy and safety of treatment in difficult-to-treat HCC patients, especially those with advanced stage HCC. From November 2017 to April 2021, 118 consecutive patients with non-resectable difficult-to-treat HCC were included in this study. All patients were treated with Ultra-FP therapy. After the weak DEB-TACE procedure, we administered low-dose FP for 2 weeks followed by resting for 4 weeks. The numbers of HCC patients CR/PR/SD/PD induced by Ultra-FP therapy were 36/52/17/13 (Modified RECIST) patients, respectively. The objective response rate of Ultra-FP therapy was 74.6% (88/118 patients). Tumor marker reduction was observed in 81.4% (96/118 patients). The objective response rate (ORR) in the HCC patients with portal vein tumor thrombosis (PVTT) was 75% (18/24 patients). Median overall survival (mOS) of all included HCC patients was 738 days. The mOS of HCC patients with PVTT (−)/PVTT (+) was 816 days/718 days. The proportion of patients based on ALBI grade system was not significantly different between pre- and after 3 course Ultra-FP therapy. Ultra-FP therapy might be an affordable treatment option for difficult-to-treat advanced HCC. ORR and overall survival after receiving Ultra-FP therapy were remarkable in comparison to various kinds of systemic therapy including MTA and iCIs.

Transcatheter Arterial Chemoembolization Combined with Hepatic Arterial Infusion Chemotherapy Versus Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

“…The findings revealed that patients treated with TACE plus HAIC demonstrated improved survival outcomes, enhanced tumor response rates, and comparable risks of adverse events compared to those receiving TACE alone. Notably, previous single-arm studies have also reported on the efficacy of TACE plus HAIC, 16 - 18 suggesting that this combined treatment modality may emerge as another viable option for individuals with unresectable HCC. A combination strategy such as this offers numerous advantages: TACE disrupts tumor blood flow, leading to prolonged exposure of the tumor to high concentrations of chemotherapy drugs.…”

“… 14 , 15 Recent studies, particularly in East Asia, have investigated the efficacy and safety of combining TACE and HAIC for unresectable HCC. 16 - 18 Comparative to TACE monotherapy, the synergistic effects of TACE plus HAIC not only induce partial tumor necrosis and diminish tumor volume by impeding blood supply but also enhance antitumor immune responses triggered by the resulting necrotic tissue. Overall, the independent antitumor mechanisms of chemoembolization, combined with the localized high drug concentration achieved through HAIC, may collectively achieve superior therapeutic effects and reduce the risk of chemotherapy resistance-associated tumor progression.…”

“…Although previous studies have provided supporting evidence for the efficacy and safety of the TACE plus HAIC strategy, 16 - 18 a comprehensive understanding of the advantages and disadvantages of combination treatment compared to TACE monotherapy remains elusive without compelling randomized controlled trials (RCTs). Additionally, concerns exist regarding the potential reduction in the diffusion of chemotherapeutic drugs during subsequent HAIC, which could theoretically impact treatment outcomes.…”

Enhancing Targeted Therapy in Hepatocellular Carcinoma through a pH-Responsive Delivery System: Folic Acid-Modified Polydopamine-Paclitaxel-Loaded Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) Nanoparticles

“…Chemotherapy remains the primary treatment modality for advanced-stage HCC diagnoses. 7,8 Therefore, the development of novel chemotherapy strategies for HCC is an urgent necessity across all stages of HCC treatment.…”

“…However, due to the scarcity of available organs for transplantation, the high risk of relapse, and late-stage detection, these treatment choices are limited to a small subset of patients. Chemotherapy remains the primary treatment modality for advanced-stage HCC diagnoses. , Therefore, the development of novel chemotherapy strategies for HCC is an urgent necessity across all stages of HCC treatment.…”