TACE with degradable starch microspheres (DSM-TACE) as second-line treatment in HCC patients dismissing or ineligible for sorafenib
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To date, there is no approved second-line treatment for patients dismissing sorafenib or ineligible for this treatment, so it would be useful to find an effective alternative treatment option. The aim of our study was to evaluate safety, feasibility and effectiveness of transarterial chemoembolisation with degradable starch microspheres (DSM-TACE) in the treatment of patients with advanced hepatocellular carcinoma (HCC) dismissing or ineligible for multikinase-inhibitor chemotherapy administration (sorafenib) due to unbearable side effects or clinical contraindications.
Forty consecutive BCLC stage B or C patients (31 male; age, 70.6 ± 13.6 years), with intermediate or locally advanced HCC dismissing or ineligible for sorafenib administration, who underwent DSM-TACE treatment cycle via lobar approach were prospectively enrolled. Tumour response was evaluated on multidetector computed tomography based on mRECIST criteria. Primary endpoints were safety, tolerance and overall disease control (ODC); secondary endpoints were progression-free survival (PFS) and overall survival (OS).
Technical success was achieved in all patients. No intra/peri-procedural death/major complications occurred. No signs of liver failure or systemic toxicity were detected. At 1-year follow-up, ODC of 52.5% was registered. PFS was 6.4 months with a median OS of 11.3 months.
DSM-TACE is safe and effective as a second-line treatment in HCC patients dismissing or ineligible for sorafenib.
• DSM-TACE is safe and effective as second-line treatment in HCC patients dismissing or ineligible for sorafenib
• DSM-TACE allows the temporary occlusion of the smaller arterial vessels, improving overall therapeutic effectiveness by reducing the immediate wash-out of the cytostatic agent
• DSM-TACE also decreases the risk of systemic toxicity and post-embolic syndrome
KeywordsHepatocellular carcinoma Chemoembolisation Therapeutic Sorafenib Precision medicine
Barcelona Clinic Liver Cancer stage B
Barcelona Clinic Liver Cancer stage C
Degradable starch microspheres – transarterial chemoembolisation
Eastern Cooperative Oncology Group
Japan Society of Hepatology
Overall disease control
Overall response rate
Progression free survival
Selective internal radiotherapy
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Roberto Iezzi, MD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• performed at one institution
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