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Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma (HCC): What’s New for This Old Treatment?

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 August 2021) | Viewed by 10555

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Prof. Thomas Decaens

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Service d'Hépato-Gastroentérologie et d’Oncologie Digestive, CHU Grenoble-Alpes, Grenoble 38043, France.
Université Grenoble Alpes, 38000 Grenoble, France.
Institute for Advanced Biosciences, Research Center Inserm U 1209 / CNRS 5309, 38700 La Tronche, France.
Interests: hepatocellular carcinoma; treatment; immunity; animal models; pre-clinical tests; liver transplantation

Special Issue Information

Dear Colleagues,

Transarterial chemoembolization has been used for many years for the treatment of hepatocellular carcinoma and it is one of the most used treatments in the world. Recent worldwide data show that TACE is associated with 40% of objective response after the first cure including 14% of complete response.

However, there is a lack of strong scientific evidence for efficacy and safety due to lack of large recent randomized control trials. There is still a debate on the real place of TACE in the HCC treatment arsenal. Immunotherapy in HCC opens new ways and opportunities.

This Special Issue will highlight the place of TACE in this new area.

Prof. Thomas Decaens
Guest Editor

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Keywords

HCC
TACE
immunotherapy
interventional radiologist
liver transplantation

Published Papers (4 papers)

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Research

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15 pages, 2159 KiB

Open AccessArticle

Effect of Transarterial Chemoembolization on ALBI Grade in Intermediate-Stage Hepatocellular Carcinoma: Criteria for Unsuitable Cases Selection

by Chen-Ta Chi, I-Cheng Lee, Rheun-Chuan Lee, Ya-Wen Hung, Chien-Wei Su, Ming-Chih Hou, Yee Chao and Yi-Hsiang Huang

Cancers 2021, 13(17), 4325; https://doi.org/10.3390/cancers13174325 - 27 Aug 2021

Cited by 8 | Viewed by 2052

Abstract

Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC). We aimed to identify unsuitable cases who were at risk of ALBI-grade migration by TACE. Consecutive 531 BCLC-B HCC patients undergoing TACE were reviewed, and factors associated with ALBI-grade migration were analyzed. There were 129 (24.3%) patients experienced acute ALBI-grade migration after TACE, and 85 (65.9%) out of the 129 patients had chronic ALBI-grade migration. Incidences of acute ALBI-grade migration were 13.9%, 29.0% for patients within or beyond up-to-7 criteria (p < 0.001) and 20.0%, 36.2% for patients within or beyond up-to-11 criteria (p < 0.001), respectively. HBV infection, tumor size plus tumor number criteria were risk factors associated with acute ALBI-grade migration. Bilobar tumor involvement was the risk factor of chronic ALBI-grade migration in patients with acute ALBI-grade migration. Up-to-eleven (p = 0.007) performed better than up-to-seven (p = 0.146) to differentiate risk of dynamic ALBI score changes. Moreover, ALBI-grade migration to grade 3 has adverse effect on survival. In conclusion, tumor burden beyond up-to-eleven was associated with ALBI-grade migration after TACE, indicating that up-to-eleven can select TACE-unsuitable HCC patients who are at risk of liver function deterioration. Full article

(This article belongs to the Special Issue Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma (HCC): What’s New for This Old Treatment?)

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11 pages, 1840 KiB

Open AccessArticle

Combination of Sorafenib and Transarterial Chemoembolization in Selected Patients with Advanced-Stage Hepatocellular Carcinoma: A Retrospective Cohort Study at Three German Liver Centers

by Christine Koch, Markus Göller, Eckart Schott, Oliver Waidmann, Mark op den Winkel, Philipp Paprottka, Stephan Zangos, Thomas Vogl, Wolf Otto Bechstein, Stefan Zeuzem, Frank T. Kolligs and Jörg Trojan

Cancers 2021, 13(9), 2121; https://doi.org/10.3390/cancers13092121 - 28 Apr 2021

Cited by 15 | Viewed by 2087

Abstract

Background and Aims. Systemic treatment with sorafenib has been the standard of care (SOC) in patients with advanced Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) for more than a decade. TACE has been reported to allow better local tumor control in selected patients with BCLC stage C HCC. Methods. A retrospective analysis of patients with BCLC stage C HCC that were treated with sorafenib and TACE was conducted; they were compared to BCLC stage C patients treated either with TACE or sorafenib in the same period of time outside a clinical trial. Results. A total of 201 patients with BCLC stage C were identified, who were treated with either sorafenib and TACE (group A; n = 54), sorafenib (group B; n = 82) or TACE (group C; n = 65). No significant difference in baseline characteristics was observed. Time to progression was 7.0 months (95% CI: 4.3–9.7), 4.1 months (95% CI: 3.6–4.7) and 5.0 months (95% CI: 2.9–7.1) in groups A, B and C, respectively, and overall survival was 16.5 months (95% CI: 15.0–18.1), 8.4 months (95% CI: 6.0–10.8) and 10.5 months (95% CI: 7.5–13.6), respectively (group A vs. group B: p < 0.001; group A vs. group C: p = 0.0023). Adverse events of grade 3/4 occurred in 34% of patients in group A. Conclusions. Although sorafenib is a SOC in patients with BCLC stage C HCC, TACE is frequently used as an additional locoregional treatment in selected patients. This combined approach resulted in a significant overall survival benefit in selected patients, although randomized trials have not yet proven this benefit. Full article

(This article belongs to the Special Issue Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma (HCC): What’s New for This Old Treatment?)

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13 pages, 1932 KiB

Open AccessArticle

Comparison of Trans-Arterial Chemoembolization and Bland Embolization for the Treatment of Hepatocellular Carcinoma: A Propensity Score Analysis

by Gaël S. Roth, Maxime Benhamou, Yann Teyssier, Arnaud Seigneurin, Mélodie Abousalihac, Christian Sengel, Olivier Seror, Julien Ghelfi, Nathalie Ganne-Carrié, Lorraine Blaise, Olivier Sutter, Thomas Decaens and Jean-Charles Nault

Cancers 2021, 13(4), 812; https://doi.org/10.3390/cancers13040812 - 15 Feb 2021

Cited by 11 | Viewed by 2750

Abstract

No definitive conclusion could be reached about the role of chemotherapy in adjunction of embolization in the treatment of hepatocellular carcinoma (HCC). We aim to compare radiological response, toxicity and long-term outcomes of patients with hepatocellular carcinoma (HCC) treated by trans-arterial bland embolization (TAE) versus trans-arterial chemoembolization (TACE). We retrospectively included 265 patients with HCC treated by a first session of TACE or TAE in two centers. Clinical and biological features were recorded before the treatment and radiological response was assessed after the first treatment using modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Correlation between the treatment and overall, progression-free and transplantation-free survival was performed after adjustment using a propensity score matching: 86 patients were treated by bland embolization and 179 patients by TACE, including 44 patients with drug-eluting beads and 135 with lipiodol TACE, 89.8% of patients were male with a median age of 65 years old. Cirrhosis was present in 90.9% of patients with a Child Pugh score A in 84% of cases. After adjustment, no difference in the rate of AE, including liver failure, was observed between the two treatments. TACE was associated with a significant increase in complete radiological response (odds ratio (OR) = 8.5 (95% confidence interval (CI): 2.8–25.4)) but not in the overall response rate (OR = 2.2 (95% CI = 0.8–5.8)). No difference in terms of overall survival (p = 0.3905), progression-free survival (p = 0.4478) and transplantation-free survival (p = 0.9020) was observed between TACE and TAE. TACE was associated with a higher rate of complete radiological response but without any impact on overall radiological response, progression-free survival and overall survival compared to TAE. Full article

(This article belongs to the Special Issue Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma (HCC): What’s New for This Old Treatment?)

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Review

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22 pages, 1321 KiB

Open AccessReview

In the Era of Systemic Therapy for Hepatocellular Carcinoma Is Transarterial Chemoembolization Still a Card to Play?

by Ana-Maria Bucalau, Illario Tancredi and Gontran Verset

Cancers 2021, 13(20), 5129; https://doi.org/10.3390/cancers13205129 - 13 Oct 2021

Cited by 4 | Viewed by 2826

Abstract

Conventional transarterial embolization (cTACE) has been proven to be effective for intermediate stage hepatocellular carcinoma (HCC), with a recent systematic review showing an overall survival (OS) of 19.4 months. Nevertheless, due to the rapid development of the systemic therapeutic landscape, the place of TACE is becoming questionable. Is there still a niche for TACE in the era of immunotherapy and combination treatments such as atezolizumab–bevacizumab, which has shown an OS of 19.2 months with excellent tolerance? The development of drug-eluting microspheres (DEMs) has led to the standardization of the technique, and along with adequate selection, it showed an OS of 48 months in a retrospective study. In order to increase treatment selectivity, new catheters have also been added to the TACE arsenal as well as the use of cone-beam CT (CBCT), which provides three-dimensional volumetric images and guidance during procedures. Moreover, the TACE indications have also widened. It may serve as a “bridging therapy” for liver transplantation candidates while they are on the waiting list, and it represents a valuable downstaging tool to transplantation criteria. The aim of this review is to explore the current data on the advancements of TACE and its future place amongst the growing panel of treatments. Full article

(This article belongs to the Special Issue Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma (HCC): What’s New for This Old Treatment?)

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