Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

Affonso, Breno Boueri; Galastri, Francisco Leonardo; Motta-Leal-Filho, Joaquim Maurício da; Nasser, Felipe; Falsarella, Priscila Mina; Cavalcante, Rafael; Almeida, Márcio Dias de; Felga, Guilherme Eduardo Gonçalves; Valle, Leonardo Guedes Moreira; Wolosker, Nelson

doi:10.3748/wjg.v25.i37.5687

Cited by 46 publications

(37 citation statements)

References 38 publications

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“…Thus, the response to downstaging has an important role in predicting tumor aggressiveness (Mazzaferro et al, 2011;Yao et al, 2015). Among locoregional therapies to downstage HCC, TACE is widely used and investigated in clinical practice (Parikh et al, 2015;Bryce and Tsochatzis, 2017;Affonso et al, 2019) and in small case-series regarding TACE with degradable starch microspheres (Orlacchio et al, 2015). DSM-TACE represents an option with respect to conventional TACE with lipiodol or TACE with drug-eluting beads (DEB-TACE) (Gross and Albrecht, 2020).…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in the Downstaging of Intermediate-Stage Hepatocellular Carcinoma (HCC) in Patients With a Child-Pugh Score of 8-9

et al. 2021

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According to the EASL Guidelines for the management of hepatocellular carcinoma, transcatheter arterial chemoembolization is the first-line treatment recommended for intermediate-stage HCC. Furthermore, it is widely accepted that patients beyond the Milan criteria can be considered for a liver transplant after successful downstaging to within the Milan criteria. Response to downstaging treatments significantly influences not just drop-outs, but also the rate of post-transplantation tumor recurrences. TACE with degradable starch microspheres represents an alternative to conventional TACE with lipiodol and TACE with drug-eluting beads, and it leads to transient arterial occlusion allowing lower activation of hypoxia-inducible factors and less release of vascular endothelial growth factor, a promoter of neoangiogenesis, tumor proliferation, and metastatic growth. In patients with intermediate-stage HCC and a Child-Pugh score of 8 or 9, life expectancy may be dominated by cirrhotic liver dysfunction, rather than by the tumor progression itself; hence, locoregional treatments might also be detrimental, precipitating liver dysfunction to an extent that survival is shortened rather than prolonged. Data on tolerability, toxicity, and effectiveness of DSM-TACE are limited but encouraging. Between January 2015 and October 2020, 50 consecutive patients with intermediate-stage hepatocellular carcinoma and a Child-Pugh score of 8/9, who had undergone DSM-TACE as the first-line treatment, were eligible for the study. A total of 142 DSM-TACEs were performed, with a mean number of 2.84 procedures per patient. The mean time-to-downstaging was 19.2 months, with six patients successfully downstaged. OS was about 100% at six months, 81.8% at 12 months, and 50% at 24 months. Twenty-two patients experienced adverse events after chemoembolization. The median OS and safety of DSM-TACE in this study are comparable with other published investigations in this field. Furthermore, 12% of patients were successfully downstaged. Hence, the results of the current investigation demonstrate that DSM-TACE is effective and safe in intermediate-stage HCC, achieving an interesting downstaging rate. Such data were observed in the population subset with a Child-Pugh score of 8 or 9, in which life expectancy may be determined by cirrhotic liver dysfunction, so the achievement of a balance between the safety and efficacy profile of the TACE treatment is crucial.

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Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in the Downstaging of Intermediate-Stage Hepatocellular Carcinoma (HCC) in Patients With a Child-Pugh Score of 8-9

et al. 2021

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“…In appropriately selected cases, LRTs can achieve complete pathologic necrosis rates of 50%-70% in targeted tumors (7,8) and reduce the risk of local recurrence (9). Transarterial chemoembolization has been long recognized as a standard-of-care therapy for intermediate disease (10), and both transarterial chemoembolization (11) and transarterial radioembolization (12) have demonstrated similar efficacies as bridging and downstaging treatments in liver transplant candidates.…”

mentioning

confidence: 99%

Safety and Efficacy of Locoregional Treatment during Immunotherapy with Nivolumab for Hepatocellular Carcinoma: A Retrospective Study of 41 Interventions in 29 Patients

Marinelli

Cedillo

Pasik

et al. 2020

Journal of Vascular and Interventional Radiology

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Materials and Methods: A single-center retrospective review included 29 patients undergoing 41 LRTs-transarterial chemoembolization or yttrium-90 transarterial radioembolization-60 days before or concurrently with nivolumab. Demographic, clinical, and laboratory values and adverse events were reviewed before and after nivolumab initiation and after each LRT. Treatment response and time to progression were assessed using Modified Response Evaluation Criteria in Solid Tumors. Clinical events, including nivolumab termination, death, and time of last follow-up, were assessed.Results: Over a median nivolumab course of 8.1 months (range, 1.0-30) with a median of 14.2 2-week cycles (range, 1-53), predominantly Child-Pugh A (22/29) patients-12 Barcelona Clinic Liver Cancer (BCLC) B and 17 BCLC C-underwent 20 transarterial chemoembolization and 21 transarterial radioembolization LRTs at a median of 67 days (range, 48-609) after nivolumab initiation. Ten patients underwent multiple LRTs. During a median follow-up of 11.5 months (range, 1.8-35.1), no grade III/IV adverse events attributable to nivolumab were observed. There were five instances of grade III/IV hypoalbuminemia or hyperbilirubinemia within 3 months after LRT. There were no nivolumab-related deaths, and 30-day mortality after LRT was 0%.

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“…Other studies have also con rmed this conclusion. The LT reported for the bridging group was 66% while the downstaging was 34% [27].…”

Section: Discussionmentioning

confidence: 93%

Application of Transcatheter Arterial Embolization Sequential Surgery in the Treatment of Liver Cancer

Liu

Zhu

et al. 2021

Preprint

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Background Preoperative transcatheter arterial embolization (TACE) is conducive to improve the surgery rate and prognosis of hepatocellular carcinoma (HCC) patients. This study aimed to evaluate the reasons and treatment effects of preoperative TACE as well as its influence on the surgery outcome.Method A total of 22 HCC patients (aged 36–68) undergoing TACE sequential surgery were retrospectively reviewed in our centers between January 2018 and August 2020. The parameters reasons, response of tumor to TACE, objective remission rate (ORR) and disease control rate (DCR), downstaging rate, abdominal adhesion and arterial injury were statistically analyzed.Results The reasons of preoperative TACE included downstaging (45.5%, 10/22), bridging therapy (22.7%, 5/22), individual choice (13.7%, 3/22), definite diagnosis (9.1%, 2/22), control of liver tumor bleeding (4.5%, 1/22) and patients with cerebral infarction (4.5%,1/22). A total of 6 complete response (CR) cases (27.3%) and 2 pathological CR (PCR) cases (9.1%) were noted. The ORR was 63.6% (14 / 22) and the DCR 90.9 % (20/22). The success rate of downstaging was 50.0% (6/12) in the patients not aiming at downstaging and 10% (1 /10) in the patients aiming at downstaging. The incidences of abdominal adhesion and arterial injury were 90.9% (20/22) and 45.5% (5/11). Conclusion TACE can be used in preoperative conversion therapy for patients who are temporarily unsuitable for surgery and is more suitable for bridging therapy in liver transplantation patients compared with downstaging due to the high DCR. Surgery should be carried out following TACE even in patients with CR.

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Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

Cited by 46 publications

References 38 publications

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in the Downstaging of Intermediate-Stage Hepatocellular Carcinoma (HCC) in Patients With a Child-Pugh Score of 8-9

Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in the Downstaging of Intermediate-Stage Hepatocellular Carcinoma (HCC) in Patients With a Child-Pugh Score of 8-9

Safety and Efficacy of Locoregional Treatment during Immunotherapy with Nivolumab for Hepatocellular Carcinoma: A Retrospective Study of 41 Interventions in 29 Patients

Application of Transcatheter Arterial Embolization Sequential Surgery in the Treatment of Liver Cancer

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