Recent Advances in the Treatment of Hepatocellular Carcinoma

Amit G. Singal; Jorge A. Marrero

Disclosures

Curr Opin Gastroenterol. 2010;26(3):189-195. 

In This Article

Transarterial Chemoembolization

Large HCC are highly dependent on hepatic arterial supply, whereas the rest of the liver derives most of its blood flow from the portal vein. TACE involves selective delivery of intra-arterial chemotherapy into the tumor, followed by embolization with a goal of inducing tissue necrosis. TACE results in a significantly prolonged 2-year survival of 63% compared with 27% with supportive care.[37] Although attempts are made to be as selective as possible, there is often some injury to surrounding hepatic parenchyma.

There is also a high degree of variability in procedural technique, with some centers using doxorubicin alone and others adding mitomycin-C or 5-fluorouracil. There is also heterogeneity in the embolizing agent, with some centers using gel foam and others using microparticles. The recent introduction of drug-eluding beads loaded with doxorubicin may help to reduce some of this heterogeneity between centers. These drug-eluding beads can maintain higher intratumor levels of doxorubicin and may also be embolic at the same time. A small phase II trial with 27 patients using drug-eluding beads loaded with doxorubicin showed a response rate of 66% and 2-year survival rates of 88.9%.[38] This has been subsequently repeated in a larger cohort of 71 patients who had repeat embolizations with doxorubicin-loaded beads every 3 months.[39] The sustained objective response rate was 66% with 1 and 2-year survival rates of 97 and 91%, respectively. Although all patients developed postembolization syndrome, grade 3–4 toxicities were seen in only 4%. Although these results are promising, further randomized controlled trials comparing drug-eluding beads to conventional TACE are still needed.

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