TACE and Radiotherapy Combination Improve HCC Survival

A combination of transarterial chemoembolization (TACE) plus external beam radiotherapy may improve patient survival compared with sorafenib in patients with locally advanced hepatocellular carcinoma (HCC) showing macroscopic vascular invasion.

Among patients with macroscopic vascular invasion, sorafenib is the standard treatment option, despite its poor response and survival benefit. Observational studies looking at a combination of TACE plus external beam radiotherapy have suggested that the combination therapy may be superior to sorafenib, but this is the first randomized clinical trial to address this question.

In the trial published in JAMA Oncology, researchers detailed the results of their study that included 90 treatment-naïve patients with liver-confined HCC showing macroscopic vascular invasion. The patients were randomized to receive either 400 mg of sorafenib twice daily, or TACE every 6 weeks plus radiotherapy within 3 weeks of the first TACE procedure.

There were 77 male patients and 13 female patients. Patients had a median age of 55 years and a median tumor diameter of 9.7 cm, with most patients (78.9%) having multiple lesions. Response Evaluation Criteria in Solid Tumors (RECIST) criteria were used during an independent review process that evaluated patients’ response. Twelve-week progression-free survival was assessed as the primary endpoint.

The progression-free survival rate at 12 weeks was significantly higher in the TACE radiotherapy group (86.7%) than in the sorafenib group (34.3%). Additionally, at 24 weeks, the TACE radiotherapy group had a significantly higher radiologic response rate (33.3%) than the sorafenib group (2.2%), as well as a significantly longer median time to progression (31.0 weeks vs 11.7 weeks) and significantly longer overall survival (55.0 weeks vs 43.0 weeks). Five patients in the TACE radiotherapy group underwent curative surgical resection as a result of downstaging, and no patients in the TACE radiotherapy group had to stop treatment because of hepatic decompensation.

The authors concluded, “"Further studies are needed to confirm our findings and, given the poor overall patient survival even with TACE plus radiotherapy, to further improve patient outcome."

Reference

Moon SM, Ryoo BY, Lee SJ. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol. Published online March 15, 2018. doi:10.1001/jamaoncol.2017.5847