Transarterial Radioembolization May Effectively Treat HCC Refractory to Chemoembolization

Transarterial radioembolization (TARE) is safe and can be an effective method of treatment for patients with intermediate or advanced-stage HCC that does not respond to transarterial chemoembolization (TACE), according to a study published in Cardiovascular and Interventional Radiology. Such patients also have potential to downstage to liver transplantation after TARE treatment.

Patients with unresectable HCC most commonly receive TACE as their logoregional treatment. However, if chemoembolization is no longer possible, they are typically only able to utilize a systemic therapy such as sorafenib as an alternative.

“The current study shows that radioembolization may be an alternative to sorafenib in patients with intermediate and advanced stage HCC who are refractory to TACE, with a good survival and safety profile,” the researchers wrote.

There were 30 patients in the retrospective study, which included all patients who underwent one or more sessions of TACE with drug-eluting beads (DEB-TACE) and subsequently received TARE for HCC. The patients underwent these treatments in the period 2007 to 2016.

Before receiving TARE, patients had a mean of 1.7 TACE procedures. After receiving TARE, several grade 3 adverse events occurred, including fatigue in 20% of patients. Approximately 10% of patients had bilirubin increase, while 3.3% had cholecystitis, and 3.3% had gastric ulcer.

MRI revealed a response in 36.7% of patients, and 3 patients (10%) were downstaged within Milan criteria and received liver transplants.

Patients survived for a median of 32.3 months after their first TACE and for a median of 14.8 months after TARE.

The authors acknowledged the limitations of the study’s retrospective design and suggested that randomized controlled trials be conducted to compare sorafenib with TARE in HCC patients who are refractory to TACE.

Reference

Klompenhouwer EG, Dresen RC, Verslype C, et al. Safety and efficacy of transarterial radioembolisation in patients with intermediate or advanced stage hepatocellular carcinoma refractory to chemoembolisation. Cardiovasc Intervent Radiol. 2017 Jul 6. doi: 10.1007/s00270-017-1739-5. [Epub ahead of print].