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Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations

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Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignancies and the third leading cause of cancer-related deaths globally. Hepatic arterial infusion chemotherapy (HAIC) treatment is widely accepted as one of the alternative therapeutic modalities for HCC owing to its local control effect and low systemic toxicity. Nevertheless, although accumulating high-quality evidence has displayed the superior survival advantages of HAIC of oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) compared with standard first-line treatment in different scenarios, the lack of standardization for HAIC procedure and remained controversy limited the proper and safe performance of HAIC treatment in HCC. Therefore, an expert consensus conference was held on March 2023 in Guangzhou, China to review current practices regarding HAIC treatment in patients with HCC and develop widely accepted statements and recommendations. In this article, the latest evidence of HAIC was systematically summarized and the final 22 expert recommendations were proposed, which incorporate the assessment of candidates for HAIC treatment, procedural technique details, therapeutic outcomes, the HAIC-related complications and corresponding treatments, and therapeutic scheme management.

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Data availability

All data included in this study are available upon request by contact with the corresponding author (drmingzhao@outlook.com).

Abbreviations

AEs:

Adverse events

AFP:

Alpha-fetoprotein

BTC:

Betacellulin

CCL28:

C–C motif chemokine ligand 28

c-TACE:

Conventional TACE

CTLA-4:

Cytotoxic T lymphocyte-associated antigen 4

DCR:

Disease control rate

DEB-TACE:

Drug-eluting bead TACE

EHS:

Extrahepatic spread

FOLFOX:

The combined chemotherapeutic regimen of oxaliplatin, leucovorin, and fluorouracil

GRADE:

The grading of recommendations assessment, development, and evaluation system

HAIC:

Hepatic arterial infusion chemotherapy

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

ICIs:

Immune checkpoint inhibitors

MTAs:

Molecular targeting agents

MVI:

Macrovascular invasion

OS:

Overall survival

PDGFR:

Platelet-derived growth factor receptor

PD-L1:

Programmed cell death 1

PVTT:

Portal vein tumor thrombosis

RCTs:

Randomized controlled trials

TACE:

Transarterial chemoembolization

TARE:

Transarterial radioembolization

TRAE:

Treatment-related adverse events

TKIs:

Tyrosine kinase inhibitors

VEGFR:

Vascular endothelial growth factor receptor

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Authors and Affiliations

  1. Department of Minimally Invasive Interventional Therapy, Liver Cancer Study and Service Group, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Ming Zhao, Wei-Jun Fan, Yang-Kui Gu & Ning Lyu

  2. Department of Interventional Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China

    Zhi Guo, Hai-Peng Yu & Tong-Guo Si

  3. Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China

    Ying-Hua Zou

  4. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiao Li

  5. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China

    Zhi-Ping Yan

  6. Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Min-Shan Chen

  7. Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China

    Hai-Liang Li

  8. Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China

    Ji-Jin Yang

  9. Department of Interventional Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Xiao-Ming Chen

  10. Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

    Lin-Feng Xu

  11. Hepatopancreatbiliary Center, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China

    Yue-Wei Zhang

  12. Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Kang-Shun Zhu

  13. Division of Hepatobiliary and Pancreatic Surgery, Hepatobiliary and Pancreatic Interventional Treatment Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Jun-Hui Sun

  14. Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Jia-Ping Li

  15. The Interventional Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou, China

    Yong Jin

  16. Department of Interventional Radiology, The General Hospital of Chinese People’s Liberation Army, Beijing, China

    Feng Duan

  17. Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Bin Xiong

  18. Department of Interventional Radiology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China

    Guo-Wen Yin

  19. Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China

    Hai-Lan Lin & Wen-Chang Yu

  20. Department of Interventional Therapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China

    Yi-Long Ma & Chang Zhao

  21. Department of Interventional Therapy, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China

    Hua-Ming Wang

  22. Department of Interventional Therapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Shan-Zhi Gu

  23. Departments of Interventional Oncology, Peking University Cancer Hospital and Institute, Beijing, China

    Xiao-Dong Wang & Jian-Hai Guo

  24. Department of Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Jian Zhai

  25. Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Yong-Hui Huang

  26. Department of Interventional Oncology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Wei-Yu Wang

  27. Department of Medical Oncology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China

    Hai-Feng Lin

  28. Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Jin-Zhang Chen

  29. Department of Oncology, First People’s Hospital of Foshan, Foshan Hospital of Sun Yat-Sen University, Foshan, China

    Jian-Peng Wang

  30. Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China

    Yi-Min Zhang & Jun-Zhe Yi

  31. State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China

    Ming Zhao & Ning Lyu

  32. Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China

    Ming Zhao & Ning Lyu

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  1. Ming Zhao
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Contributions

Conception and design: MZ, NL, and JZY. Provision of study material: NL. Collection and assembly of data: JZY and YMZ. Data analysis and interpretation: JZY and YMZ. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.

Corresponding author

Correspondence to Ming Zhao.

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Conflict of interest

Ming Zhao, Zhi Guo, Ying-Hua Zou, Xiao Li, Zhi-Ping Yan, Min-Shan Chen, Wei-Jun Fan, Hai-Liang Li, Ji-Jin Yang, Xiao-Ming Chen, Lin-Feng Xu, Yue-Wei Zhang, Kang-Shun Zhu, Jun-Hui Sun, Jia-Ping Li, Yong Jin, Hai-Peng Yu, Feng Duan, Bin Xiong, Guo-Wen Yin, Hai-Lan Lin, Yi-Long Ma, Hua-Ming Wang, Shan-Zhi Gu, Tong-Guo Si, Xiao-Dong Wang, Chang Zhao, Wen-Chang Yu, Jian-Hai Guo, Jian Zhai, Yong-Hui Huang, Wei-Yu Wang, Hai-Feng Lin, Yang-Kui Gu, Jin-Zhang Chen, Jian-Peng Wang, Yi-Min Zhang, Jun-Zhe Yi, Ning Lyu declare no potential conflicts of interest.

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Zhao, M., Guo, Z., Zou, YH. et al. Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations. Hepatol Int 18, 4–31 (2024). https://doi.org/10.1007/s12072-023-10599-6

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