Chemoembolization for hepatocellular carcinoma.
Author(s): Lencioni R.
Affiliation(s): Division of Diagnostic Imaging and Intervention, Pisa University School of
Medicine, Pisa, Italy. riccardo.lencioni@med.unipi.it
Publication date & source: 2012, Semin Oncol. , 39(4):503-9
Transcatheter arterial chemoembolization (TACE) is the standard of care for
patients with preserved liver function and asymptomatic, noninvasive multinodular
hepatocellular carcinoma (HCC) confined to the liver. However, the survival
benefit of conventional TACE-including the administration of an anticancer
agent-in-oil emulsion followed by embolic agents-reported in randomized
controlled trials and meta-analyses was described as modest. Various strategies
to improve outcomes for this patient group have become the subject of much
ongoing clinical research. The introduction of embolic, drug-eluting beads (DEB)
for transarterial administration has been shown to significantly reduce liver
toxicity and systemic drug exposure compared to conventional regimens. The
addition of molecular targeted drugs to the therapeutic armamentarium for HCC has
prompted the design of clinical trials aimed at investigating the synergies
between TACE and systemic treatments. Combining TACE with agents with
anti-angiogenic properties represents a promising strategy, because TACE is
thought to cause local hypoxia, resulting in a temporary increase in levels of
vascular endothelial growth factor. Recently, a large phase II randomized,
double-blind, placebo-controlled trial (the SPACE study) has shown that the
concurrent administration of DEB-TACE and sorafenib has a manageable safety
profile and has suggested that time to progression and time to vascular invasion
or extrahepatic spread may be improved with respect to DEB-TACE alone. These data
support the further evaluation of molecular targeted, systemically active agents
in combination with DEB-TACE in a phase III setting.
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