Safety and Prognosis of Transarterial Chemoembolization for Octogenarians with Hepatocellular Carcinoma

Cheng, Hua-Ming; Tanaka, Toshihiro; Nomura, Hideyuki; Chanoki, Yuto; Horiuchi, Katsutoshi; Masada, Tetsuya; Tatsumoto, Shota; Matsumoto, Takeshi; Marugami, Nagaaki; Kichikawa, Kimihiko

doi:10.1007/s00270-019-02290-x

Cited by 14 publications

(18 citation statements)

References 19 publications

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“…For higher age patients, it is important to choose optimal treatments while considering the safety and the patients’ quality of life. Previous reports showed the safety of TACE for octogenarians with HCC 45 . Further investigations are needed to compare both efficacy and safety between TACE and lenvatinib for higher age patients.…”

Section: Discussionmentioning

confidence: 96%

Transarterial‐ chemoembolization remains an effective therapy for intermediate‐stage hepatocellular carcinoma with preserved liver function

Saito

Tanaka

Nishiohuku

et al. 2020

Hepatology Research

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To evaluate outcomes as well as prognostic factors of transarterial chemoembolization (TACE) in intermediate stage hepatocellular carcinoma (HCC) with preserved liver function to determine positioning of TACE. Methods: Of 158 treatment naïve patients with intermediate stage HCC who received initial TACE from February 2007 to January 2016, 113 patients met the following inclusion criteria: no combined therapy within 4 weeks after initial TACE, and Child-Pugh score under 7. Response rate and overall survival were evaluated. The prognostic factors were investigated in univariate and multivariate analyses using Cox proportional hazards models. The deterioration of liver function after repeated TACE was also evaluated. Results: The response rate was 92.7% (complete response, 63.3%; partial response, 29.4%). The median survival time was 45.2 months. Survival rates at 1, 2, and 3 years were 90.4%, 77.0%, and 60.8% respectively. Age ≥ 75 years (P=0.022), serum α fetoprotein level ≥ 200 ng/mL (P=.010), tumor number ≥ 11 (P=0.008), and heterogeneous enhancement on dynamic computed tomography (P=0.024) were poor prognostic factors. The deterioration rate of Child-Pugh score and albuminbilirubin grade was 18.5% and 12.3%, respectively, after the first TACE, 15.6% and 5.1%, respectively, after the second TACE, and 14.5% and 11.1%, respectively, after the third TACE. Conclusion: Superselective TACE can achieve high tumor response rates with prolonged overall survival for patients with intermediate stage HCC with preserved liver function. Age, serum α fetoprotein level, tumor number ≥ 11, and heterogeneous enhancement on dynamic computed tomography indicated significantly poor prognosis.

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Section: Discussionmentioning

confidence: 96%

Transarterial‐ chemoembolization remains an effective therapy for intermediate‐stage hepatocellular carcinoma with preserved liver function

Saito

Tanaka

Nishiohuku

et al. 2020

Hepatology Research

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“…Data from real life suggest that TACE is preferred by physicians in the elderly population even in patients who meet criteria for resection probably because of the risk of surgical complications 10,11 …”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, because of its well‐tolerability and safety, TACE is largely preferred in elderly even when patients meet criteria for resection 10,11 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…However, in a Japanese population of octogenarians, Cheng et al [262] found that the performance status (ECOG 0) was the only independent prognostic significant factor, and that adverse events and OS rates were not different in the octogenarians.…”

Section: Transarterial Chemoembolizationmentioning

confidence: 96%

New landscapes and horizons in hepatocellular carcinoma therapy

Cervello

Emma

Augello

et al. 2020

Aging

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Hepatocellular carcinoma (HCC), is the sixth most frequent form of cancer and leads to the fourth highest number of deaths each year. HCC results from a combination of environmental factors and aging as there are driver mutations at oncogenes which occur during aging. Most of HCCs are diagnosed at advanced stage preventing curative therapies. Treatment in advanced stage is a challenging and pressing problem, and novel and welltolerated therapies are urgently needed. We will discuss further advances beyond sorafenib that target additional signaling pathways and immune checkpoint proteins. The scenario of possible systemic therapies for patients with advanced HCC has changed dramatically in recent years. Personalized genomics and various other omics approaches may identify actionable biochemical targets, which are activated in individual patients, which may enhance therapeutic outcomes. Further studies are needed to identify predictive biomarkers and aberrantly activated signaling pathways capable of guiding the clinician in choosing the most appropriate therapy for the individual patient.

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Safety and Prognosis of Transarterial Chemoembolization for Octogenarians with Hepatocellular Carcinoma

Cited by 14 publications

References 19 publications

Transarterial‐ chemoembolization remains an effective therapy for intermediate‐stage hepatocellular carcinoma with preserved liver function

Transarterial‐ chemoembolization remains an effective therapy for intermediate‐stage hepatocellular carcinoma with preserved liver function

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

New landscapes and horizons in hepatocellular carcinoma therapy

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