Management of intermediate‐stage hepatocellular carcinoma in the elderly with transcatheter arterial chemoembolization failure: Retreatment or switching to systemic therapy?

Abstract

Background Transcatheter Arterial chemoembolization (TACE) is the first‐line option for the intermediate‐stage hepatocellular carcinoma. Guidelines do not define the number of TACE sessions to be repeated before stopping treatment and switching to sorafenib. Methods We retrospectively analysed 76 patients aged ≥65 years who were treated by multiple TACE sessions (re‐TACE group; N = 36 patients) or one TACE session followed by sorafenib (TACE/Sorafenib group; N = 40 patients). The primary outcome was the overall survival (Kaplan‐Meier analysis and log‐rank test). Results Median overall survival was 320 days (range: 70‐420 days) in re‐TACE subgroup and 285 days (range: 50‐368 days) in TACE/Sorafenib subgroup without significant differences between the two groups (log‐rank test P = .72; HR = 0.87; 95% IC 0.41‐1.87). The survival rate at one year was 43.6% and 32% in the re‐TACE and in the TACE/sorafenib groups (P = .12), respectively. Subgroup analysis by gender, number of nodules at baseline and etiology of liver cirrhosis was performed but no differences were found. No statistical difference was observed in the frequency of side effects, but sorafenib was associated with severe diarrhoea in most patients requiring dose reduction. Conclusion In our study including HCC patients aged ≥65 years, no differences in survival rate and side effects were found between patients Retreated with further TACE sessions and patients with treatment stage migration to sorafenib after first TACE failure. We included in our analysis a small study population; therefore, larger prospective studies are needed to confirm these findings.

Hepatic arterial infusion chemotherapy combined with lenvatinib and PD‐1 inhibitors versus lenvatinib and PD‐1 inhibitors for HCC refractory to TACE

“…18,19 Sorafenib, a representative oral tyrosine kinase inhibitor (TKI) agent that can target vascular endothelial growth factor (VEGF) to normalize tumor vasculature, has displayed inspiring tumor control and prognosis for subsequent treatment after TACE refractoriness. 13,20 Shimose et al found that TACE-refractory patients treated with lenvatinib reached a significantly longer median PFS than those treated with sorafenib and TACE (5.8 vs 3.2 vs 2.4 months). 21 Compared with sorafenib, lenvatinib is another oral TKI that involves more potent inhibition of VEGFR and a distinct mechanism of action with unique inhibition of fibroblast growth factor receptor in patients with advanced HCC.…”

“…TACE refractoriness/failure is speculated to be related to tumor neovascularization after consecutive superselective TACE procedures 18,19 . Sorafenib, a representative oral tyrosine kinase inhibitor (TKI) agent that can target vascular endothelial growth factor (VEGF) to normalize tumor vasculature, has displayed inspiring tumor control and prognosis for subsequent treatment after TACE refractoriness 13,20 . Shimose et al .…”

Subsequent Treatment after Transarterial Chemoembolization Failure/Refractoriness: A Review Based on Published Evidence

“…The long treatment time after tumor progression may have challenged the efficacy of sorafenib. Recently, Villani et al25 reported results that conflicted with those of the two aforementioned studies. Their study included 76 elderly patients ≥65 years of age with intermediate-stage HCC after TACE failure/refractoriness.…”