Safety and efficacy of drug-eluting bead transarterial chemoembolization with CalliSpheres® microsphere for hepatocellular carcinoma with portal vein tumor thrombus: a preliminary study

Zhou, Tianyu; Chen, Sheng-Qun; Wang, Hongliang; Weng, Sheng-Ming; Zhou, Gengui; Zhang, Yuelin; Nie, Chun‐Hui; Zhu, Tian; Wang, Baoquan; Yu, Zi-Niu; Li, Jing; Chen, Feng; Sun, Junhui

doi:10.7150/jca.54650

Cited by 14 publications

(7 citation statements)

References 29 publications

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“…A most recently published study demonstrated that the higher Child-Pugh classification and liver tumor burden were independent prognostic factors associated with poor survival for HCC patients with PVTT treated by DEB-TACE. 26 Interestingly, these significant risk factors revealed by their study were consistent with another retrospective study conducted by Gorodetski et al, 9 but not with ours. The reasons for this discrepancy might be that the sample sizes for these 2 studies were relatively small with only 58 and 38 patients enrolled, respectively, and no validations were performed to prove the reliability of their results.…”

Section: Discussionsupporting

confidence: 90%

Development of a Prognostic Nomogram in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Following Trans-Arterial Chemoembolization with Drug-Eluting Beads

Cheng¹,

Yu²,

Liu³

et al. 2021

CMAR

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Objective To develop and validate a prognostic nomogram in eastern patients with hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) receiving trans-arterial chemoembolization with drug-eluting beads (DEB-TACE). Methods This retrospective study included 200 patients with training cohort (n = 118) from institution 1 and test cohort (n = 82) from institution 2. All these patients received first-line DEB-TACE between October 2016 and October 2018. Multivariate Cox proportional hazard regression analysis was performed on the training cohort to reveal the independent prognostic factors, and then prognostic nomograms were developed. In order to evaluate the performance of the nomogram comprehensively in both the training and test cohorts, C-index, Kaplan–Meier curve with Log rank test, receiver operating characteristic curve (ROC), calibration plot, and decision curve analysis (DCA) were performed. Results Tumor number, serum γ-glutamyl transferase (GGT) level, and level of PVTT were independent risk factors of prognosis. A nomogram was constructed to predict 6-, 12- and 18-month overall survival (OS) based on these identified prognostic factors. C-indexes of the nomogram were 0.88 (95% confidence interval [CI], 0.79–0.97) in the training cohort and 0.87 (95% CI, 0.75–0.99) in the test cohort. The Kaplan–Meier curve analysis showed that the nomogram was able to separate patients into low- and high-risk subgroups. ROC curves for the nomogram at 6-, 12- and 18-month showed satisfied discrimination, with an AUC of 0.765, 0.803 and 0.809 in the training cohort, respectively, and 0.772, 0.724 and 0.746 in the test cohort, respectively. The calibration curve demonstrated good agreement between predicted and actual survival rates in the training and test cohorts. The decision curve showed good performance of the nomogram in terms of clinical application. Conclusion We developed and validated a nomogram that was accurate and clinically useful in eastern patients with HBV-associated HCC with PVTT who underwent DEB-TACE.

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Section: Discussionsupporting

confidence: 90%

Development of a Prognostic Nomogram in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Following Trans-Arterial Chemoembolization with Drug-Eluting Beads

Cheng¹,

Yu²,

Liu³

et al. 2021

CMAR

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“…Initiation and follow-up of treatment were carried out at one of four centers, with baseline dynamic contrast-enhanced computed tomography (CT) imaging obtained within 7 days before treatment. PVTT was confirmed by enhanced CT or enhanced Magnetic Resonance Imaging (MRI), the imaging features of PVTT included solid lesions within the portal vein in all the phases of intravenous enhanced 3-phase computed tomography, especially with an enhancement of contrast in the arterial phase and washout in the portal venous phase of the procedure ( 22 ).…”

Section: Methodsmentioning

confidence: 99%

“…As has previously been reported ( 22 ), TACE was performed by administering doxorubicin mixed with 5–20 mL lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, France) to both groups. The dose of doxorubicin was 50–75 mg/m 2 (Haizheng Pharmaceutical Co. Ltd., China) adjusted based on patient liver function, tumor size, vascularity, presence of an arterioportal shunt, and body surface area.…”

Section: Methodsmentioning

confidence: 99%

Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Transarterial Chemoembolization and Sorafenib vs.125Iodine Implantation

Luo

Cao

et al. 2021

Front. Oncol.

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Background and AimsThis study investigated the feasibility, safety, and efficacy of transarterial chemoembolization (TACE) combined with CT-guided 125iodine seed implantation for treatment of hepatocellular carcinoma (HCC) with first-branch portal vein tumor thrombosis (PVTT).MethodsThis prospective, controlled, multicenter study included HCC patients with Barcelona Clinic Liver Cancer stage C disease and PVTT in the right and/or left portal veins. Patients were treated with either TACE and sorafenib or TACE and CT-guided 125iodine seed implantation and regularly evaluated for clinical response and adverse events, with treatment termination resulting from declining clinical status, loss to follow-up, or death.ResultsThis study demonstrated a significant between-group difference in median overall survival (OS); therefore, it was terminated early. A total of 123 patients were included in this study, with 52 patients in the TACE-sorafenib group and 71 patients in the TACE-125iodine group, without significant differences in baseline characteristics between groups. The median OS was 8.3 months (95% CI: 6.105–10.495) in the TACE-sorafenib group and 13.8 months (95% CI: 9.519–18.081) in the TACE-125iodine group. In a subgroup analysis of type IIa versus type IIb PVTT, the median OS was 17.5 months for type IIa and 7.1 months for IIb in the TACE-125iodine group. The median OS was 9.3 months for IIa and 4.0 months for IIb in the TACE-sorafenib group. Univariate and multivariate analyses confirmed that the PVTT type and treatment strategy were significant independent factors affecting OS. The objective response rates (ORR) for intrahepatic lesions and PVTT showed significant differences between groups. Most patients in both groups experienced minor adverse events related to TACE. The overall incidence of sorafenib-related adverse events or toxic effects was 90.4% in TACE-sorafenib group. In the TACE-125iodine group, the incidence of pneumothorax and minor hepatic subcapsular hemorrhage were 7.04% and 9.86%, respectively.ConclusionsThis study showed that TACE-125iodine treatment significantly enhanced survival of patients with HCC and type II PVTT, especially subtype IIa, with minimal adverse events.Clinical Trial RegistrationChinese Clinical Trials Database, identifier ChiCTR-ONN-16007929.

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“…Also the combination of DEB-TACE with microsphere in HCC patients with PVTT has been reported safe, well tolerated and with promising preliminary clinical outcomes (the survival rate at 6, 12, 18, and 24 months was 72.4,% 41.4%, 22.4%, and 19%, respectively). 143 …”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

Khan¹,

Wei²,

Xu³

2021

JHC

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Portal vein involvement is considered one of the most fearful complications of hepatocellular carcinoma (HCC). Portal vein tumor thrombosis (PVTT) is associated with aggressive tumor biology (high grade), high tumor burden (number and size of lesions), high levels of serum markers (AFP), poor liver function (deranged LFT), and poor performance status of patients. The Barcelona Clinic Liver Cancer staging system places HCC patients with PVTT in advanced stage (BCLC Stage-C). This group contains a fairly heterogeneous patient population, previously considered candidates for palliative systemic therapy with sorafenib. However, this provided modest overall survival (OS) benefit. The results of a recent Phase III (IMbrave150) trial favor the combination of atezolizumab and bevacizumab over sorafenib as a standard of care in advanced unresectable HCC. While only lenvatinib proved to be non-inferior against sorafenib in a phase III (REFLECT trial), regorafenib (RESORCE trial), ramucirumab (REACH-2), and cabozantinib (CELESTIAL) have been approved second-line therapy in phase III clinical trials. Recently, the data on the prospect of other modalities in the management of HCC with PVTT is mounting with favorable results. Targeting multiple pathways in the HCC cascade using a combination of drugs and other modalities such as RT, TACE, TARE, and HAIC appear effective for systemic and loco-regional control. The quest for the ideal combination therapy and the sequence set is still widely unanswered and prospective trials are lacking. With the armament of available therapeutic options and the advances and refinements in the delivery system, down-staging patients to make them eligible for curative resection has been reported. In a rapidly evolving treatment landscape, performing surgery when appropriate, in the form of LR and even LT to achieve cure does not seem farfetched. Likewise, adjuvant therapy and prompt management of the recurrences holds the key to prolong OS and DFS. This review discusses the management options of HCC patients with PVTT.

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Safety and efficacy of drug-eluting bead transarterial chemoembolization with CalliSpheres® microsphere for hepatocellular carcinoma with portal vein tumor thrombus: a preliminary study

Cited by 14 publications

References 29 publications

Development of a Prognostic Nomogram in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Following Trans-Arterial Chemoembolization with Drug-Eluting Beads

Development of a Prognostic Nomogram in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus Following Trans-Arterial Chemoembolization with Drug-Eluting Beads

Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Transarterial Chemoembolization and Sorafenib vs.125Iodine Implantation

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

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