HCC: for TACE treatment, twice may be enough

  • Choi J & al.
  • PLoS One
  • 1 Jan 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Intermediate-stage or outside the Milan criteria hepatocellular carcinoma (HCC) patients with no objective response (OR) after 2 consecutive transarterial chemoembolization (TACE) sessions rarely benefited from a third.

Why this matters

  • No evidence-based criteria are available for when to stop TACE treatments, although consensus-based guidelines suggest switching to systemic treatment after 2 attempts that fail to achieve an OR.

Study design

  • Retrospective analysis at a single center in the Republic of Korea (n=200; 91.0% male).
  • Funding: Bayer.

Key results

  • The mean size of the largest tumor was 6.8 cm.
  • 40.5% of patients had 4 or more tumors.
  • The overall response rate after 2 TACE sessions was 36.9%.
  • After 1 TACE session, 24.0% achieved a complete response, 43.5% a partial response, and 29.5% stable disease; 3.0% experienced progressive disease.
  • 22.5% of patients had no OR after 2 successive TACE sessions.
    • In this group, 28 patients went on to a third TACE session, with an OR rate of 10.7%.
  • Factors associated with failure to achieve OR after 2 TACE sessions included tumor size >5 cm (adjusted odds ratio [aOR], 3.74; P=.003) and alpha-fetoprotein >200 ng/mL (aOR, 3.11; P=.005).

Limitations

  • Retrospective, single-center study; Asian population.