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Transarterial Chemoembolisation (TACE) with Degradable Starch Microspheres (DSM) and Anthracycline in Patients with Locally Extensive Hepatocellular Carcinoma (HCC): Safety and Efficacy

  • Alexander GrossEmail author
  • Thomas Albrecht
Clinical Investigation Interventional Oncology
Part of the following topical collections:
  1. Interventional Oncology

Abstract

Purpose

To evalutate safety and efficacy of degradable starch microspheres (DSM) as embolic agent in transarterial chemoembolisation (TACE) of unresectable, locally extensive hepatocellular carcinoma (HCC).

Materials and Methods

In this retrospective study, 37 patients with intermediate to advanced HCC treated with ≥ 3 chemoembolisations with doxorubicin/epirubicin and DSM were analysed. Patients were treated with three consecutive chemoembolisations in 4-weekly intervals. Clinical parameters and laboratory findings were obtained from patient records before and after each intervention. Tumour response was assessed after every 3 embolisations by CT/MRI according to modified response evaluation criteria in solid tumours.

Results

Thirty-seven patients with HCC were treated with 177 DSM-TACEs (3–12/patient, mean 4.8). Disease stages according to the Barcelona Clinic Liver Cancer (BCLC) staging system were: 27 × B, 9 × C, 1 × D. Five patients had uninodular, 32 multinodular (23 bilobar) disease. Three patients had portal vein invasion. Apart from one possibly procedure-related grade 3 complication, only grade 1 adverse events occurred. These were pain reacting to analgesics (23%), transient nausea (11%), vomiting (3%) and post-embolisation syndrome (4%). Transient laboratory changes were bone marrow toxicity (29%) and increase in INR (14%), creatinine (8%) or bilirubin (38%). Tumour response was objective response rate 49%, disease control rate 83%. Median survival was 19 months: 22 months for BCLC stage B and 6.7 months for BCLC stages C + D. Responders had a significantly better prognosis than non-responders.

Conclusion

DSM-TACE of HCC is safe even in patients with advanced disease stages. Tumour response and survival rates were encouraging in our series of patients with locally extensive disease.

Keywords

Transarterial chemoembolisation TACE Degradable starch microspheres DSM Hepatocellular carcinoma HCC 

Notes

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

Alexander Gross has received travel grants and a speaker honorarium from PharmaCept GmbH (Berlin, Germany). Thomas Albrecht has received travel grants and speaker honoraria from PharmaCept GmbH (Berlin, Germany).

Consent for Publication

The study was approved by the local ethics committee (Ethikkommission der Ärztekammer Berlin).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The study was approved by the local ethics committee (Ethikkommission der Ärztekammer Berlin).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359(9319):1734–9.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Lo C-M, Ngan H, Tso W-K, Liu C-L, Lam C-M, Poon RT-P, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35(5):1164–71.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.CrossRefGoogle Scholar
  4. 4.
    Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology. 2004;127(5 Suppl 1):S179–88.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Aronsen KF, Hellekant C, Holmberg J, Rothman U, Teder H. Controlled blocking of hepatic artery flow with enzymatically degradable microspheres combined with oncolytic drugs. Eur Surg Res. 1979;11(2):99–106.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Forsberg JO. Transient blood flow reduction induced by intra-arterial injection of degradable starch microspheres. Experiments on rats. Acta Chir Scand. 1978;144(5):275–81.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Lindell B, Aronsen KF, Rothman U. Repeated arterial embolization of rat livers by degradable microspheres. Eur Surg Res. 1977;9(5):347–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Lote K, Myking AO. Starch microsphere induced small intestinal ischaemia. Blood flow and morphologic investigations of late effects. Acta Radiol Oncol. 1982;21(5):353–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Dakhil S, Ensminger W, Cho K, Niederhuber J, Doan K, Wheeler R. Improved regional selectivity of hepatic arterial BCNU with degradable microspheres. Cancer. 1982;50(4):631–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Ebert M, Ebert J, Berger G. Intravital microscopic research of microembolization with degradable starch microspheres. J Drug Deliv. 2013;2013:242060.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Håkansson L, Håkansson A, Morales O, Thorelius L, Warfving T. Spherex (degradable starch microspheres) chemo-occlusion–enhancement of tumor drug concentration and therapeutic efficacy: an overview. Semin Oncol. 1997;24(2 Suppl 6):S6-100–9.Google Scholar
  12. 12.
    Sigurdson ER, Ridge JA, Daly JM. Intra-arterial infusion of doxorubicin with degradable starch microspheres. Improvement of hepatic tumor drug uptake. Arch Surg. 1986;121(11):1277–81.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Li X, Feng G-S, Zheng C-S, Zhuo C-K, Liu X. Expression of plasma vascular endothelial growth factor in patients with hepatocellular carcinoma and effect of transcatheter arterial chemoembolization therapy on plasma vascular endothelial growth factor level. World J Gastroenterol. 2004;10(19):2878–82.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Wang B, Xu H, Gao ZQ, Ning HF, Sun YQ, Cao GW. Increased expression of vascular endothelial growth factor in hepatocellular carcinoma after transcatheter arterial chemoembolization. Acta Radiol. 2008;49(5):523–9.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Xiao E-H, Guo D, Bian D-J. Effect of preoperative transcatheter arterial chemoembolization on angiogenesis of hepatocellular carcinoma cells. World J Gastroenterol. 2009;15(36):4582–6.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Pawlik TM, Reyes DK, Cosgrove D, Kamel IR, Bhagat N, Geschwind J-FH. Phase II trial of sorafenib combined with concurrent transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. J Clin Oncol. 2011;29(30):3960–7.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Ye W. The complexity of translating anti-angiogenesis therapy from basic science to the clinic. Dev Cell. 2016;37(2):114–25.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Niessen C, Unterpaintner E, Goessmann H, Schlitt HJ, Mueller-Schilling M, Wohlgemuth WA, et al. Degradable starch microspheres versus ethiodol and doxorubicin in transarterial chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol. 2014;25(2):240–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Iezzi R, Pompili M, Nestola M, Siciliano M, Annicchiarico E, Zocco MA, et al. Transarterial chemoembolization with degradable starch microspheres (DSM-TACE): an alternative option for advanced HCC patients? Preliminary results. Eur Rev Med Pharmacol Sci. 2016;20(13):2872–7.PubMedGoogle Scholar
  20. 20.
    Yamasaki T, Hamabe S, Saeki I, Harima Y, Yamaguchi Y, Uchida K, et al. A novel transcatheter arterial infusion chemotherapy using iodized oil and degradable starch microspheres for hepatocellular carcinoma: a prospective randomized trial. J Gastroenterol. 2011;46(3):359–66.PubMedCrossRefGoogle Scholar
  21. 21.
    de Baere T, Arai Y, Lencioni R, Geschwind J-F, Rilling W, Salem R, et al. Treatment of liver tumors with lipiodol TACE: technical recommendations from experts opinion. Cardiovasc Interv Radiol. 2016;39(3):334–43.CrossRefGoogle Scholar
  22. 22.
    Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30(1):52–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Common Terminology Criteria for Adverse Events (CTCAE), Version 4.03. US Department of Health and Human Services; National Institutes of Health, National Cancer Institute. 2010Google Scholar
  24. 24.
    Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6.CrossRefGoogle Scholar
  25. 25.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.CrossRefGoogle Scholar
  26. 26.
    Reynolds AR, Furlan A, Fetzer DT, Sasatomi E, Borhani AA, Heller MT, et al. Infiltrative hepatocellular carcinoma: what radiologists need to know. Radiographics. 2015;35(2):371–86.PubMedCrossRefGoogle Scholar
  27. 27.
    Marelli L, Stigliano R, Triantos C, Senzolo M, Cholongitas E, Davies N, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Interv Radiol. 2007;30(1):6–25.CrossRefGoogle Scholar
  28. 28.
    Craig P, Young S, Golzarian J. Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: variability in technical aspects. Cardiovasc Interv Radiol. 2019;42(9):1322–8.CrossRefGoogle Scholar
  29. 29.
    Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Interv Radiol. 2010;33(1):41–52.CrossRefGoogle Scholar
  30. 30.
    Facciorusso A. Drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma: current state of the art. World J Gastroenterol. 2018;24(2):161–9.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Golfieri R, Giampalma E, Renzulli M, Cioni R, Bargellini I, Bartolozzi C, et al. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer. 2014;111(2):255–64.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Ikeda M, Arai Y, Park SJ, Takeuchi Y, Anai H, Kim JK, et al. Prospective study of transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: an Asian cooperative study between Japan and Korea. J Vasc Interv Radiol. 2013;24(4):490–500.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Kudo M, Han G, Finn RS, Poon RTP, Blanc J-F, Yan L, et al. Brivanib as adjuvant therapy to transarterial chemoembolization in patients with hepatocellular carcinoma: a randomized phase III trial. Hepatology. 2014;60(5):1697–707.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Gruber-Rouh T, Schmitt C, Naguib NNN, Nour-Eldin NA, Eichler K, Beeres M, et al. Transarterial chemoembolization (TACE) using mitomycin and lipiodol with or without degradable starch microspheres for hepatocellular carcinoma: comparative study. BMC Cancer. 2018;18(1):188.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Brown KT, Do RK, Gonen M, Covey AM, Getrajdman GI, Sofocleous CT, et al. Randomized trial of hepatic artery embolization for hepatocellular carcinoma using doxorubicin-eluting microspheres compared with embolization with microspheres alone. J Clin Oncol. 2016;34(17):2046–53.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind J-FH. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology. 2016;64(1):106–16.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Orlacchio A, Chegai F, Francioso S, Merolla S, Monti S, Angelico M, et al. Repeated transarterial chemoembolization with degradable starch microspheres (DSMs-TACE) of unresectable hepatocellular carcinoma: a prospective pilot study. Curr Med Imaging Rev. 2018;14(4):637–45.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Schicho A, Pereira PL, Haimerl M, Niessen C, Michalik K, Beyer LP, et al. Transarterial chemoembolization (TACE) with degradable starch microspheres (DSM) in hepatocellular carcinoma (HCC): multi-center results on safety and efficacy. Oncotarget. 2017;8(42):72613–20.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Kirchhoff TD, Rudolph KL, Layer G, Chavan A, Greten TF, Rosenthal H, et al. Chemoocclusion vs chemoperfusion for treatment of advanced hepatocellular carcinoma: a randomised trial. Eur J Surg Oncol. 2006;32(2):201–7.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Burrel M, Reig M, Forner A, Barrufet M, de Lope CR, Tremosini S, et al. Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using drug eluting beads. Implications for clinical practice and trial design. J Hepatol. 2012;56(6):1330–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Malagari K, Pomoni M, Moschouris H, Bouma E, Koskinas J, Stefaniotou A, et al. Chemoembolization with doxorubicin-eluting beads for unresectable hepatocellular carcinoma: five-year survival analysis. Cardiovasc Interv Radiol. 2012;35(5):1119–28.CrossRefGoogle Scholar
  42. 42.
    Furuse J, Ishii H, Satake M, Onaya H, Nose H, Mikami S, et al. Pilot study of transcatheter arterial chemoembolization with degradable starch microspheres in patients with hepatocellular carcinoma. Am J Clin Oncol. 2003;26(2):159–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Radiology and Interventional TherapyVivantes Klinikum NeuköllnBerlinGermany

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