Drug‐eluting beads <i>versus</i> conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma

Facciorusso, Antonio; Mariani, Luigi; Sposito, Carlo; Spreafico, Carlo; Bongini, Marco; Morosi, Carlo; Cascella, Tommaso; Marchianò, Alfonso; Camerini, Tiziana; Bhoori, Sherrie; Brunero, Federica; Barone, M.; Mazzaferro, Vincenzo

doi:10.1111/jgh.13147

Cited by 74 publications

(50 citation statements)

References 19 publications

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“…DC Beads TACE may provide improved survival rates and quality of life to some extent as compared to cTACE[32,41,47,49]. However, several RCTs and meta-analysis do not demonstrate significant survival advantages of DC Beads TACE[30,31,42].…”

Section: Resultsmentioning

confidence: 99%

“…There was no statistically significant difference in median OS between cTACE and DEB-TACE (11.4 mo vs 18.4 mo, respectively). Facciorusso et al[32] also reported that median survival of early/intermediate stage HCC patients ( n = 249) between cTACE and DC Beads TACE showed insignificant differences (39 mo vs 32 mo, respectively, P = 0.1).…”

Section: Survivalmentioning

confidence: 99%

“…Also, Sacco et al[31] showed statistically insignificant differences in CR and PR rates at 1 mo between DC Beads TACE and cTACE (51.5% and 48.5% vs 70.6% and 29.4%, respectively, P = 0.1). Facciorusso et al[32] reported single center study with early/intermediate HCC patients ( n = 249). In this study, cTACE showed better tumor response and time to progression (TTP).…”

Section: Response To DC Beads Tacementioning

confidence: 99%

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Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Nam¹,

Jang²,

Song³

2016

WJG

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Transarterial chemoembolization (TACE) is a widely used standard treatment for patients with hepatocellular carcinoma (HCC) who are not suitable candidates for curative treatments. The rationale for TACE is that intra-arterial chemotherapy using lipiodol and chemotherapeutic agents, followed by selective vascular embolization, results in a strong cytotoxic effect as well as ischemia (conventional TACE). Recently, drug-eluting beads (DC Beads®) have been developed for transcatheter treatment of HCC to deliver higher doses of the chemotherapeutic agent and to prolong contact time with the tumor. DC Beads® can actively sequester doxorubicin hydrochloride from solution and release it in a controlled sustained fashion. Treatment with DC Beads® substantially reduced the amount of chemotherapeutic agent that reached the systemic circulation compared with conventional, lipiodol-based regimens, significantly reducing drug-related adverse events. In this article, we describe the treatment response, survival, and safety of TACE used with drug-eluting beads for the treatment of HCC and discuss future therapeutic possibilities.

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Section: Resultsmentioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

Section: Response To DC Beads Tacementioning

confidence: 99%

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Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Nam¹,

Jang²,

Song³

2016

WJG

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“…Several consecutive sessions are usually needed for DEB-TACE to be effective, i.e ., the complete tumor response, so that the optimal treatment should lead to higher tumor necrosis rate with the lowest incidence of adverse event. DEB-TACE showed a low incidence of PES[13] and systemic toxicity than in previous reports[8], but its superiority over c-TACE is still a matter of debate[10,24-26]. …”

Section: Discussionmentioning

confidence: 99%

Transarterial chemoembolization using 40 µm drug eluting beads for hepatocellular carcinoma

Greco¹,

Cascella²,

Facciorusso³

et al. 2017

WJR

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AIMTo assess the safety and efficacy of transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) using a new generation of 40 μm drug eluting beads in patients not eligible for curative treatment.METHODSDrug eluting bead TACE (DEB-TACE) using a new generation of microspheres (embozene tandem, 40 μm) preloaded with 100 mg of doxorubicin was performed on 48 early or intermediate HCC patients with compensated cirrhosis. Response to therapy was assessed with Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) guidelines applied to computed tomography or magnetic resonance imaging. Eleven out of the 48 treated patients treated progressed on to receive liver orthotopic transplantation (OLT). This allowed for histological analysis on the treated explanted nodules.RESULTSDEB-TACE with 40 μm showed a good safety profile without major complications or 30-d mortality. The objective response rate of treated tumors was 72.6% and 26.7% according to mRECIST and RECIST respectively. Histological examination in 11 patients assigned to OLT showed a necrosis degree > 90% in 78.6% of cases. The overall time to progression was 13 mo (11-21).CONCLUSIONDEB-TACE with 40 μm particles is an effective treatment for the treatment of HCC in early-intermediate patients (Barcelona Clinic Liver Cancer stage A/B) with a good safety profile and good results in term of objective response rate and necrosis.

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“…Although subgroup analysis according to the adopted TACE regimen was unfeasible due to the low number of studies, we know from previous cohort studies that DEB-TACE and cTACE lead to similar outcomes and comparable side effects in HCC patients [44, 45]. …”

Section: Discussionmentioning

confidence: 99%

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

et al. 2016

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Trans-arterial radioembolization (TARE) is a recognized, although not explicitly recommended, experimental therapy for unresectable hepatocellular carcinoma (HCC).A systematic literature review was performed to identify published studies on the use of TARE in intermediate and advanced stages HCC exploring the efficacy and safety of this innovative treatment.Twenty-one studies reporting data on overall survival (OS) and time to progression (TTP), were included in a meta-analysis. The pooled post-TARE OS was 63% (95% CI: 56-70%) and 27% (95% CI: 21-33%) at 1- and 3-years respectively in intermediate stage HCC, whereas OS was 37% (95% CI: 26-50%) and 13% (95% CI: 9-18%) at the same time intervals in patients with sufficient liver function (Child-Pugh A-B7) but with an advanced HCC because of the presence of portal vein thrombosis. When an intermediate and advanced case-mix was considered, OS was 58% (95% CI: 48-67%) and 17% (95% CI: 12-23%) at 1- and 3-years respectively. As for TTP, only four studies reported data: the observed progression probability was 56% (95% CI: 41-70%) and 73% (95% CI: 56-87%) at 1 and 2 years respectively. The safety analysis, focused on the risk of liver decompensation after TARE, revealed a great variability, from 0-1% to more than 36% events, influenced by the number of procedures, patient Child-Pugh stage and treatment duration.Evidence supporting the use of radioembolization in HCC is mainly based on retrospective and prospective cohort studies. Based on this evidence, until the results of the ongoing randomized trials become available, radioembolization appears to be a viable treatment option for intermediate-advanced stage HCC.

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Drug‐eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma

Abstract: In a large series of Western hepatocellular carcinoma patients, drug-eluting beads chemoembolization with 100-300 µm particles did not seem to improve survival in comparison with conventional chemoembolization, which in turn provided better tumor responses and time to progression.

Cited by 74 publications

References 19 publications

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Transarterial chemoembolization with drug-eluting beads in hepatocellular carcinoma

Transarterial chemoembolization using 40 µm drug eluting beads for hepatocellular carcinoma

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

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