Conventional Transarterial Chemoembolization Versus Drug-Eluting Beads in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Hepatocellular carcinoma (HCC) occurs in nearly three-quarters of all primary liver cancers, with the majority not amenable to curative therapies. We therefore aimed to re-evaluate the safety, efficacy, and survival benefits of treating patients with drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) compared to the conventional transcatheter arterial chemoembolization (C-TACE). Several databases were searched with a strict eligibility criterion for studies reporting on adult patients with unresectable or recurrent HCC. The pooled analysis included 34 studies involving 4841 HCC patients with a median follow-up of 1.5 to 18 months. There were no significant differences between DEB-TACE and C-TACE with regard to complete response, partial response and disease stability. However, disease control (OR: 1.42 (95% CI (1.03,1.96) and objective response (OR: 1.33 (95% CI (0.99, 1.79) were significantly more effective for DEB-TACE treatment with fewer severe complications and all-cause mortality. The pooled-analysis did not find superiority of DEB-TACE in complete or partial response, disease stability, controlling disease progression, and 30 day or end-mortality. However, results showed that DEB-TACE is associated with a better objective response, disease control, and lower all-cause mortality with severe complications compared to C-TACE treatment. Given that the safety outcomes are based on limited studies with a potential for bias, there was no clear improvement of DEB-TACE over C-TACE treatment.

Callispheres® Drug-Eluting Beads Transarterial Chemoembolization Might be an Efficient and Safety Down-Staging Therapy in Unresectable Liver Cancer Patients

Purpose: The purpose was to explore the effect of drug-eluting beads transarterial chemoembolization (DEB-TACE) on down-staging in unresectable liver cancer patients.Methods: 15 unresectable liver cancer patients received DEB-TACE as a down-staging treatment before hepatectomy were enrolled. Data (including demographics, histories, clinical features at diagnosis and cycles of DEB-TACE before hepatectomy) were collected. Treatment response was evaluated at one month after DEB-TACE. Tumor diameter was evaluated by abdominal computed tomography scan. The residual liver volume was evaluated by IQQA liver system, Relapse-free survival (RFS) and overall survival (OS) were calculated by Kaplan-Meier curves.Results: After DEB-TACE, 3 (20.0%) patients achieved complete response (CR) and 10 (66.7%) patients achieved objective response rate (ORR), meanwhile, 5 (27.8%) tumors achieved CR and 12 (66.7%) tumors achieved ORR. Tumor diameter was decreased after DEB-TACE compared to before DEB-TACE (9.4±3.3 vs. 5.4±3.5 cm) (P<0.01). As to residual liver volume, it was increased after DEB-TACE compared to before DEB-TACE (1066.2 cm3 vs. 1172.5 cm3) (P=0.007). More importantly, 15 (100%) patients could receive resection after DEB-TACE, (including 14 (93.3%) patients with curative resection and 1 (6.7%) patient with palliative resection). For survival, the median RFS was 26.0 months, and the percentage of 5-year accumulating RFS was 20%. As to OS, the median OS was 54.5 months, and the percentage of 5-year accumulating OS was 40%. For safety profiles, 5 patients had postoperative pain, 7 patients had fever, and 1 had nausea and vomiting.Conclusion: DEB-TACE might be an efficient and safety down-staging treatment in unresectable liver cancer patients.