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Huo YR, Xiang H, Chan MV, Chan C. Survival, tumour response and safety of 70-150 μm versus 100-300 μm doxorubicin drug-eluting beads in transarterial chemoembolisation for hepatocellular carcinoma. J Med Imaging Radiat Oncol 2019; 63:802-811. [PMID: 31709778 DOI: 10.1111/1754-9485.12971] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/28/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study investigates the outcomes and safety of 70-150 μm and 100-300 μm doxorubicin drug-eluting bead transarterial chemoembolisation (DEB-TACE) in patients with unresectable hepatocellular carcinoma (HCC). METHODS Retrospective, cohort study of 51 patients treated with DEB-TACE for unresectable HCC was studied: 23 with 100-300 μm particles and 28 with 70-150 μm particles. Overall, survival (OS), progression-free survival (PFS), tumour response and prognostic factors were assessed. RESULTS The median OS of the entire cohort was 30 months. The median OS and median PFS for 70-150 μm particles were not reached, whilst for the 100-300 μm group, it was 29.2 months and 15.0 months, respectively. The 6-month, 1-year and 2-year OS for 70-150 μm was 96%, 86% and 85% versus the 100-300 μm particles size of 83%, 64% and 44%, respectively. At 1-month follow-up, patients treated with 70-150 μm had significantly better mRECIST tumour response compared to 100-300 μm (complete response 38.5% vs. 19%; partial response 57.7% vs. 42.9%; stable disease 0% vs. 4.8%; progressive disease 3.8% vs. 33.3%, P = 0.027). Patients treated with 100-300 μm DEBs were significantly more likely to have progressive disease on 1-month follow-up imaging compared those treated with 70-150 μm DEB sizes (odds ratio 7.15, P = 0.007). The 30-day mortality rate was similar between the two groups (3.6% for 70-150 μm vs. 4.3% for 100-300 μm). Multivariate analysis demonstrated entire cohort OS was significantly associated with BCLC stage (aHR: 10.5, P = 0.002), albumin (aHR: 15.0, P = 0.02) and ALP (aHR 62, P = 0.001). CONCLUSIONS DEB-TACE with 70-150 μm particles demonstrates improved 1-month objective tumour response compared to 100-300 μm, whilst having a similar safety profile. Elevated ALP, lower albumin and higher BCLC stage were significantly associated with poorer survival outcomes.
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Affiliation(s)
- Ya Ruth Huo
- Bankstown-Campbelltown Hospital, South Western Sydney Clinical School, UNSW Medicine and the University, Sydney, New South Wales, Australia
| | - Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael Vinchill Chan
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Hospital Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Christine Chan
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Kudo M, Ueshima K, Chan S, Minami T, Chishina H, Aoki T, Takita M, Hagiwara S, Minami Y, Ida H, Takenaka M, Sakurai T, Watanabe T, Morita M, Ogawa C, Wada Y, Ikeda M, Ishii H, Izumi N, Nishida N. Lenvatinib as an Initial Treatment in Patients with Intermediate-Stage Hepatocellular Carcinoma Beyond Up-To-Seven Criteria and Child-Pugh A Liver Function: A Proof-Of-Concept Study. Cancers (Basel) 2019; 11:E1084. [PMID: 31370183 PMCID: PMC6721438 DOI: 10.3390/cancers11081084] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
Although transcatheter arterial chemoembolization (TACE) is the standard of care for intermediate-stage hepatocellular carcinoma (HCC), this is a largely heterogeneous disease that includes a subgroup of patients who do not benefit from TACE. The treatment strategy for this subgroup of patients currently remains an unmet need in clinical practice. Here, we performed a proof-of-concept study that lenvatinib may be a more favorable treatment option over TACE as an initial treatment in intermediate-stage HCC patients with large or multinodular tumours exceeding the up-to-seven criteria. This proof-of-concept study included 642 consecutive patients with HCC initially treated with lenvatinib or conventional TACE (cTACE) between January 2006 and December 2018. Of these patients, 176 who received lenvatinib or cTACE as an initial treatment and met the eligibility criteria (unresectable, beyond the up-to-seven criteria, no prior TACE/systemic therapy, no vascular invasion, no extrahepatic spread and Child-Pugh A liver function) were selected for the study. Propensity score matching was used to adjust for patient demographics. After propensity-score matching, the outcome of 30 patients prospectively treated with lenvatinib (14 in clinical trials, one in an early access program and 15 in real world settings) and 60 patients treated with cTACE as the initial treatment was compared. The change of albumin-bilirubin (ALBI) score from baseline to the end of treatment were -2.61 to -2.61 for 30 patients in the lenvatinib group (p = 0.254) and -2.66 to -2.09 in the cTACE group (p < 0.01), respectively. The lenvatinib group showed a significantly higher objective response rate (73.3% vs. 33.3%; p < 0.001) and significantly longer median progression-free survival than the cTACE group (16.0 vs. 3.0 months; p < 0.001). Overall survival was significantly longer in the lenvatinib group than in the cTACE group (37.9 vs. 21.3 months; hazard ratio: 0.48, p < 0.01). In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child-Pugh A liver function, who usually do not benefit from TACE, lenvatinib provides a more favorable outcome than TACE.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan.
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Stephan Chan
- State Key Laboratory of Translation Oncology, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong 111-1111, China
| | - Tomohiro Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Hirokazu Chishina
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Tomoko Aoki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Masahiro Takita
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Hiroshi Ida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
| | - Masahiro Morita
- Department of Gastroenterology, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Japan
| | - Chikara Ogawa
- Department of Gastroenterology, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Japan
| | - Yoshiyuki Wada
- Department of Hepatobiliary and Pancreatic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka 810-8563, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa-shi 277-8577, Japan
| | - Hiroshi Ishii
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 135-8550, Japan
- Clinical Research Center, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Namiki Izumi
- Department of Gastroenterology, Musashino Red Cross Hospital, Musashino 180-8610, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
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Gao J, Zhen R, Liao H, Zhuang W, Guo W. Pharmacokinetics of continuous transarterial infusion of 5-fluorouracil in patients with advanced hepatocellular carcinoma. Oncol Lett 2018; 15:7175-7181. [PMID: 29725440 PMCID: PMC5920382 DOI: 10.3892/ol.2018.8242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/23/2018] [Indexed: 12/12/2022] Open
Abstract
Numerous studies concerning hepatic arterial infusion chemotherapy (HAIC) have been conducted by adopting regimens containing 5-fluorouracil (FU), with a favourable efficacy compared with conventional transcatheter arterial chemoembolisation (TACE) treatment; however, the detailed mechanism of HAIC remains unclear. The present study aimed to evaluate peripheral concentration time curves of 5-FU administered through the hepatic artery, which may additionally explain the mechanism of action of HAIC. A total of 10 eligible patients underwent transcatheter arterial embolization and a 2-day HAIC treatment regimen using a folinic acid, fluorouracil and oxaliplatin regimen. Peripheral venous blood sampling was performed in each patient prior to infusion, and at 0, 0.5, 1, 1.5, 2, 5, 10, 15, 22 and 23 h following the start of infusion. The blood sample at 0 h was analysed for dihydropyrimidine dehydrogenase (DPD) levels by high performance liquid chromatography, and the rest of the samples were analysed for 5-FU by optimised liquid chromatography-mass spectrometry (LC-MS). The lower limit of quantification of optimised LC-MS for 5-FU was 5 ng/ml. The steady-state plasma concentration of 5-FU administered through the hepatic artery was achieved after 15 h. This concentration largely varied, ranging from 8.64-152.00 ng/ml. Optimised LC-MS may detect low concentrations of 5-FU. The steady-state concentration of 5-FU administered through the hepatic artery was achieved after 15 h. DPD levels were analysed through determining the ratio of plasma uracil (U) and dihydrouracil (UH2) by HPLC, and the results indicated a mild DPD deficiency in the patients with HCC. These results may provide a basis for the explanation of the clinical efficacy of HAIC, and to additionally optimise its efficacy.
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Affiliation(s)
- Jian Gao
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Rui Zhen
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Hai Liao
- Department of Clinical Trials and Research on Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510080, P.R. China
| | - Wenquan Zhuang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Wenbo Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
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Huang WK, Yang SF, You LN, Liu M, Liu DY, Gu P, Fan XW. Transcatheter arterial chemoembolisation (TACE) plus S-1 for the treatment of BCLC stage B hepatocellular carcinoma refractory to TACE. Contemp Oncol (Pozn) 2017; 20:468-474. [PMID: 28239285 PMCID: PMC5320460 DOI: 10.5114/wo.2016.65607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
AIM OF THE STUDY To assess the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus S-1 for the treatment of Barcelona Clinic Liver Cancer (BCLC) Stage B HCC refractory to TACE. MATERIAL AND METHODS 26 patients meeting the eligibility criteria were enrolled. TACE was given on day 1, and S-1 on days 2-15. Tumor assessment was performed one month later according to mRECIST. The primary endpoints were TTP and OS. RESULTS Twenty-six patients received 176 TACE interventions in all. Fifteen patients of TACE plus S-1 received a total of 55 cycles of treatment of S-1, with a median of 4 cycles (range, 2-6). The total dose of S-1 was 6165 mg per day, while average was 120 mg (range, 100-125 mg) for 15 patients of TACE plus S-1. Median TTP and OS of TACE plus S-1 were 6 months (95% CI: 4.7-7.3) and 18 months (95% CI: 15.3-24.7), respectively, while TACE monotherapy was 4 months (95% CI: 2.4-5.6) and 13 months (95% CI: 9.8-16.2), respectively, and significant differences were detected. Though there were higher DCRs in patients of TACE plus S-1, no significant differences were detected. A total of 612 adverse events occurred during the course of the treatment, 367 in TACE plus S-1 and 245 in TACE mono-therapy. There were significant differences to anorexia and nausea, but they were tolerable. CONCLUSIONS TACE plus S-1 in the present analysis was tolerable and associated with an interesting TTP and OS. TACE plus S-1 may be used as a new treatment method to BCLC Stage B HCC refractory to TACE.
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Affiliation(s)
- Wu-Kui Huang
- Department of Intervention Radiology, the Affiliated Tumour Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; These authors contributed equally to this work
| | - Shu-Fa Yang
- Department of Intervention Radiology, the Affiliated Tumour Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; These authors contributed equally to this work
| | - Li-Na You
- Department of Traditional Chinese Medicine, the Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China; These authors contributed equally to this work
| | - Mo Liu
- Department of Intervention Radiology, the Affiliated Tumour Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Deng-Yao Liu
- Department of Intervention Radiology, the Affiliated Tumour Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Peng Gu
- Department of Intervention Radiology, the Affiliated Tumour Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xi-Wen Fan
- Department of Intervention Radiology, the Affiliated Tumour Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Lu DH, Fei ZL, Zhou JP, Hu ZT, Hao WS. A comparison between three-dimensional conformal radiotherapy combined with interventional treatment and interventional treatment alone for hepatocellular carcinoma with portal vein tumour thrombosis. J Med Imaging Radiat Oncol 2014; 59:109-14. [PMID: 25088249 DOI: 10.1111/1754-9485.12207] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/15/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We investigated the therapeutic effects of three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT). METHODS Sixty-three HCC patients with PVTT were divided into two groups. Group A (30 patients) was treated with three-dimensional conformal radiotherapy followed by 2-3 series of TACE, while group B (33 patients) was only treated with TACE. RESULTS The 1- and 2-year survival rates of group A were 62.40% and 20.81%, respectively, with a mean survival time of 13.0 months. The 1- and 2-year survival rates of group B were 56.49% and 18.83%, respectively, with a mean survival time of 9.0 months. There were significant differences between the two groups (log-rank chi-square value = 3.950, P = 0.047). CONCLUSION Three-dimensional conformal radiotherapy combined with TACE can significantly improve clinical outcomes in patients with HCC and PVTT compared with TACE alone.
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Affiliation(s)
- Dong-Hui Lu
- Tumor Diagnosis and Treatment Center, 105th Hospital of PLA, Hefei, China
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Abstract
Transcatheter arterial chemoembolisation (TACE) has become the standard treatment for unresectable hepatocellular carcinoma (HCC). However, this method is often unsuccessful. The p53 gene, which is present as a mutant form in many human tumours, is known to have broad spectrum antitumour effects when expressed normally. In this study, we report a 23 year old patient with recurrent HCC who was treated with the p53 gene (Gendicine) combining TACE, which resulted in a good clinical prognosis.
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Affiliation(s)
- Y S Guan
- Department of Radiology, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China.
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