Predictive Factors for the Effectiveness of Repeated Lines of Transarterial Chemoembolization in the Treatment of Localized Hepatocellular Carcinoma
V. V. Breder,
M. Y. Pitkevich,
V. Y. Kosirev,
B. I. Dolgushin,
E. R. Virshke,
I. A. Dzhanyan,
K. K. Laktionov https://doi.org/10.37174/2587-7593-2021-4-1-42-52
Abstract
Hepatocellular carcinoma (HCC) remains the fourth leading cause of cancer-related death in the world. The progression of HCC after previously effective TACE is quite often local. This article describes our experience with repeated TACE in patients with local progression of HCC. We analyzed 125 patients with HCC, for the period from 2009 to 2015. TACE was performed for intrahepatic manifestations of HCC. Progression of HCC after TACE-1 was observed in 88.8 % (n = 111) patients. Disease progression after TACE‑2 was registered in 40 (32 %) patients. TACE‑3 was performed in 8 (6.4 %) patients. The analysis showed that isolated local intrahepatic progression of HCC with the growth of intrahepatic tumor nodes previously subjected to TACE‑1 (without new foci) does not affect OS. The efficiency of re-embolization (TACE‑2) is somewhat lower than for TACE of the first stage. Independent factors of overall survival increase in patients receiving TACE: satisfactory objective status according to ECOG, efficacy of the first stage of TACE, late progression and objective effect after re-embolization.
About the Authors
V. V. Breder
N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
24 Kashirskoye Highway, Moscow 115478
M. Y. Pitkevich
I.M. Sechenov First Moscow State Medical University
Russian Federation
Russian Federation
bld. 2, 8, Trubetskaya, Moscow 119991
V. Y. Kosirev
N.N. Blokhin National Medical Research Center of Oncology;
I.M. Sechenov First Moscow State Medical University
Russian Federation
Russian Federation
24 Kashirskoye Highway, Moscow 115478;
bld. 2, 8, Trubetskaya, Moscow 119991
B. I. Dolgushin
N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
24 Kashirskoye Highway, Moscow 115478
E. R. Virshke
N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
24 Kashirskoye Highway, Moscow 115478
I. A. Dzhanyan
N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Russian Federation
24 Kashirskoye Highway, Moscow 115478
K. K. Laktionov
N.N. Blokhin National Medical Research Center of Oncology;
N.I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
24 Kashirskoye Highway, Moscow 115478;
1 Ostrovityanova, Moscow 117997
References
1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. DOI: 10.3322/caac.21492.
2. European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908-43. DOI: 10.1016/j.jhep.2011.12.001.
3. Boland P, Wu J. Systemic therapy for hepatocellular carcinoma: beyond sorafenib. Chin Clin Oncol. 2018;7(5):50. DOI: 10.21037/cco.2018.10.10.
4. Meyer T, Fox R, Ma YT, et al. Sorafenib in combination with transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma (TACE 2): a randomised placebocontrolled, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol. 2017;2(8):565-75. DOI: 10.1016/S2468-1253(17)30156-5.
5. Breder VV. Strategy and tactics of conservative treatment of hepatocellular cancer. Moscow, 2017. (In Russ.).
6. Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, et al. JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the Liver Cancer Study Group of Japan. Liver Cancer. 2014;3:458-68). DOI: 10.1159/000343875.
7. Raoul JL, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2011;37:212-20). DOI: 10.1016/j.ctrv.2010.07.006.
8. Arizumi T, et al. Effectiveness of Sorafenib in Patients with Transcatheter Arterial Chemoembolization (TACE) Refractory and IntermediateStage Hepatocellular Carcinoma. Liver Cancer. 2015 Dec;4(4):253-62. DOI: 10.1159/000367743.
9. NCCN Clinical Practice Guidelines in Oncology. Hepatobiliary Cancers, version 3.2019. Available at: https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf).
10. Marrero JA, Kudo M, Venook AP, et al. Observational registry of sorafenib use in clinical practice across Child–Pugh subgroups: the GIDEON study. J Hepatol. 2016;65(6):1140-7. DOI: 10.1016/j.jhep.2016.07.020.
11. Matsuki M, Adachi Y, Ozawa Y, et al. Targeting of tumor growth and angiogenesis underlies the enhanced antitumor activity of lenvatinib in combination with everolimus. Cancer Sci. 2017;108(4):763-71. DOI: 10.1111/cas.13169.
12. Bruix J, Qin S, Merle P, et al. RESORCE Investigators. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389(10064):56-66. DOI: 10.1016/S0140-6736(16)32453-9.
13. Finn RS, Merle P, Granito A, et al. Outcomes of sequential treatment with sorafenib followed by regorafenib for HCC: Additional analyses from the phase III RESORCE trial. J Hepatol. 2018;69(2):353- 8. DOI: 10.1016/j.jhep.2018.04.010.
14. Zhu AX, Galle PR, Kudo M, et al. A randomized, double-blind, placebo-controlled phase 3 study of ramucirumab versus placebo as second-line treatment in patients with advanced hepatocellular carcinoma (HCC) and elevated baseline alphafetoprotein (AFP) following first-line sorafenib (REACH-2). J Clin Oncol. 2017;34(15_suppl): TPS4145-TPS4145. JCO.2016.34.15_suppl.TPS4145. DOI: 10.1016/S1470-2045(18)30937-9.
15. El-Khoueiry A.B, Sangro B, Yau T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017;389(10088):2492-502. DOI: 10.1016/S0140-6736(17)31046-2.
16. Zhu AX, Finn RS, Edeline J, et al. KEYNOTE-224 investigators. KEYNOTE-224 Investigators. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a nonrandomised, open-label phase 2 trial. Lancet Oncol. 2018;19(7):940-52. DOI: 10.1016/S1470-2045(18)30351-6.
17. Finn RS, Ryoo BY, Merle P, et al. KEYNOTE-240 investigators. Pembrolizumab as second-line therapy in patients with advanced hepatocellular carcinoma in KEYNOTE-240: A randomized, double-blind, phase III trial. J Clin Oncol. 2020;38(3):193-202. DOI: 10.1200/JCO.19.01307.
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For citations:
Breder V.V., Pitkevich M.Y., Kosirev V.Y., Dolgushin B.I., Virshke E.R., Dzhanyan I.A., Laktionov K.K. Predictive Factors for the Effectiveness of Repeated Lines of Transarterial Chemoembolization in the Treatment of Localized Hepatocellular Carcinoma. Journal of oncology: diagnostic radiology and radiotherapy. 2021;4(1):42-52. (In Russ.) https://doi.org/10.37174/2587-7593-2021-4-1-42-52
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