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TACE Plus RT Might Be Best For HCC With Macroscopic Vessel Invasion

For patients with hepatocellular carcinoma with macroscopic vascular invasion, transarterial chemoembolization plus radiotherapy may be a better first-line option than sorafenib
19 Mar 2018
Anticancer Agents;  Hepatobiliary Cancers;  Surgical Oncology;  Therapy;  Biological Therapy;  Radiation Oncology
By Lynda Williams, Senior medwireNews Reporter

medwireNews: Transarterial chemoembolization (TACE) plus radiotherapy (RT) may be superior to sorafenib for treatment-naïve patients with hepatocellular carcinoma (HCC) showing macroscopic vascular invasion, research suggests.

“Further studies are needed to confirm our findings and, given the poor overall patient survival even with TACE plus RT, to further improve patient outcome”, the South Korean investigators comment.

The 12-week progression-free survival (PFS) rate was 86.7% for the 45 patients who were randomly assigned to receive TACE every 6 weeks, consisting of an infusion of cisplatin 2 mg/kg followed by cisplatin embolization with or without gelatine sponge infusion. This group also received a maximum of 45 Gy of RT beginning within 3 weeks of the chemotherapy.

This was significantly higher than the 34.3% PFS rate at 12 weeks for the 45 patients who were instead given sorafenib 400 mg twice daily, report Young-Suk Lim, from the University of Ulsan College of Medicine in Seoul, and co-workers.

PFS at 24 weeks was also significantly higher with TACE plus RT than sorafenib (55.6 vs 7.4%), as was the 24-week rate of radiological response (33.3 vs 2.2%) and the median time to progression (31.0 vs 11.7 weeks).

And 11.1% of the patients receiving TACE plus RT were able to undergo curative surgery after their tumour was downsized, the researchers report in JAMA Oncology.

The study authors explain that 90.7% of the sorafenib-treated patients switched to TACE within 24 weeks of beginning treatment, whereas just 23.0% of the TACE plus RT group changed over to sorafenib in this time, a significant difference.

And the high rate of treatment crossover did not obscure a treatment benefit as median overall survival was also significantly longer with TACE plus RT than sorafenib (55.0 vs 43.0 weeks), “suggesting that it would be better to begin treatment with TACE plus RT than sorafenib”, Young-Suk Lim et al write.

The team admits, however, that as 84.4% of participants in the study had cancer linked to hepatitis B virus infection, “the treatment strategy described may not be extrapolatable to patients with HCC not associated with hepatitis B virus.”

Overall, TACE plus RT was “well tolerated” the authors say, and although there were five serious adverse events, none of the patients discontinued treatment because of hepatic decompensation. Five patients in the sorafenib group also had a serious adverse event.

The authors of an invited commentary write that “[p]otentially, the future for HCC therapy will continue to that multimodality treatments will outperform single-treatment paradigms”, with current research exploring combinations of transarterial and systemic approaches, targeted therapies and immune modulators.

“Furthermore, the experience with combination therapies using [external beam] RT for HCC continues to increase, with a phase 3 trial examining stereotactic body radiotherapy followed by sorafenib vs sorafenib alone currently under way”, say Khashayar Farsad, from Oregon Health & Science University in Portland, USA, and co-authors.

“For those of us managing these patients daily in our clinics and procedure suites, it is encouraging to know there is hope ahead.”

References 

Yoon SM, Ryoo B-Y, Lee SJ, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion. A randomized clinical trial. JAMA Oncol; Advance online publication 15 March 2018.
DOI:https://doi.org/10.1001/jamaoncol.2017.5847

Farsad K, Costentin CE, Zhu AX. Hepatcellular carcinoma with portal venous invasion. Radiating news hope? JAMA Oncol; Advance online publication 15 March 2018.
DOI: https://doi.org/10.1001/jamaoncol.2018.0007

Last update: 19 Mar 2018

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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