Ablative chemoembolization doubles response rate and PFS in HCC
Ablative chemoembolization (ACE) doubles response rate and progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC) compared with conventional transarterial chemoembolization (cTACE), a study by the Chinese University of Hong Kong (CUHK) has shown.
In the prospective phase I study in patients with newly diagnosed HCC, complete response (CR) rate was 100 percent among those treated with ACE (n=22), compared with 45.5 percent among those who underwent cTACE (n=22) (p<0.0001). [Radiology 2018;287:340-348]
“Median PFS was 28 months in the ACE group compared with 10 months in the cTACE group [p<0.0001]. The rate of disease progression was 53.3 percent among patients treated with ACE, compared with 100 percent among patients treated with cTACE [p=0.001],” said investigator Professor Simon Yu of the Department of Imaging and Interventional Radiology, CUHK.
Patients treated with ACE also had a significantly lower rate of intratumoural disease progression (6.7 percent vs 78.9 percent for cTACE; p<0.0001), while rates of extratumoural intrahepatic progression (33.3 percent vs 31.6 percent; p>0.999) and extrahepatic progression (20 percent vs 0 percent; p=0.076) were not significantly different between the two groups.
ACE was also associated with a trend towards an increased rate of conversion to hepatectomy. “Seven patients [31.8 percent] in the ACE group and three patients [13.6 percent] in the cTACE group eventually underwent hepatectomy, but the between-group difference was not statistically significant [p=0.281],” reported Yu.
“In terms of tumour response, 6-month CR rate was 100 percent among all tumours treated with ACE, compared with 43.3 percent for tumours treated with cTACE. At the end of follow-up, 4.8 percent of tumours treated with ACE and 74.1 percent of tumours treated with cTACE showed intratumoural progression,” he continued.
On histological analysis, evidence of viable residual HCC was found in 25 percent of specimens in the ACE group vs 100 percent of specimens in the cTACE group (p=0.026).
In the study, ACE was administered using a lipiodol-ethanol solution mixed in a 2:1 ratio with the addition of cisplatin. Patients underwent two treatment sessions given 2 months apart.
“The new technique of ACE significantly increases the concentration of chemotherapeutic drugs delivered to HCC tissue,” explained Yu.
The procedure was safe and well tolerated in all patients, with no immediate complications or need for sedatives or analgesics. No periprocedural death, irreversible liver impairment, renal function deterioration or hepatobiliary sepsis was reported. Reversible periprocedural liver function derangement occurred in 18.2 percent of patients in the ACE group compared with 13.6 percent of patients in the cTACE group (p>0.999).
Based on these findings, the investigators concluded that ACE is safe, well tolerated, highly effective, and probably more effective than cTACE for the treatment of HCC.
“ACE can be considered in patients with intermediate-stage HCC with ≤5 tumours, with each tumour having a diameter of ≤12 cm and a total tumour volume of ≤50 percent of hepatic volume,” Yu suggested. “The cost of treatment is HKD 6,000–7,000, compared with HKD 2,000–3,000 for cTACE, HKD 10,000–20,000 for drug-eluting beads TACE and HKD 70,000–80,000 for selective internal radiation therapy.”