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TACE with degradable starch microspheres (DSM-TACE) as second-line treatment in HCC patients dismissing or ineligible for sorafenib

  • Interventional
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Abstract

Objectives

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.

Methods

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).

Results

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.

Conclusions

DSM-TACE is safe and effective as a second-line treatment in HCC patients dismissing or ineligible for sorafenib.

Key Points

• 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

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Abbreviations

BCLC-B:

Barcelona Clinic Liver Cancer stage B

BCLC-C:

Barcelona Clinic Liver Cancer stage C

CR:

Complete response

DSM-TACE:

Degradable starch microspheres – transarterial chemoembolisation

ECOG:

Eastern Cooperative Oncology Group

HCC:

Hepatocellular carcinoma

JSH:

Japan Society of Hepatology

ODC:

Overall disease control

ORR:

Overall response rate

OS:

Overall survival

PFS:

Progression free survival

PR:

Partial response

SD:

Stable disease

SIRT:

Selective internal radiotherapy

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy

    Roberto Iezzi, AnnaMaria De Gaetano, Alessandro Posa, Francesca Carchesio & Riccardo Manfredi

  2. Dipartimento di Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy

    Maurizio Pompili, Emanuele Rinninella, Eleonora Annicchiarico, Matteo Garcovich, Lucia Cerrito, Francesca Ponziani, Massimo Siciliano, Maria Assunta Zocco, GianLodovico Rapaccini, Marco Biolato & Antonio Gasbarrini

  3. Dipartimento di Oncologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy

    Michele Basso

  4. Dipartimento di Chirurgia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy

    Felice Giuliante

Authors
  1. Roberto Iezzi
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  2. Maurizio Pompili
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  3. Emanuele Rinninella
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  4. Eleonora Annicchiarico
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  6. Lucia Cerrito
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  9. Massimo Siciliano
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  10. Michele Basso
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  11. Maria Assunta Zocco
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  14. Francesca Carchesio
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  15. Marco Biolato
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  16. Felice Giuliante
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  18. Riccardo Manfredi
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Consortia

the HepatoCatt Study Group

Corresponding author

Correspondence to Roberto Iezzi.

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Guarantor

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• experimental

• performed at one institution

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Iezzi, R., Pompili, M., Rinninella, E. et al. TACE with degradable starch microspheres (DSM-TACE) as second-line treatment in HCC patients dismissing or ineligible for sorafenib. Eur Radiol 29, 1285–1292 (2019). https://doi.org/10.1007/s00330-018-5692-8

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  • DOI: https://doi.org/10.1007/s00330-018-5692-8

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