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Meta-Analysis
. 2023 Feb;12(3):2590-2599.
doi: 10.1002/cam4.5125. Epub 2022 Aug 9.

TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta analysis

Andrew M Brown  1 , Ihab Kassab  1 , Marco Massani  2 , Whitney Townsend  1 , Amit G Singal  3 , Cigdem Soydal  4 , Laura Moreno-Luna  5 , Lewis R Roberts  5 , Vincent L Chen  1 , Neehar D Parikh  1
Affiliations
Meta-Analysis

TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta analysis

Andrew M Brown et al. Cancer Med. 2023 Feb.

Abstract

Background: Transarterial radioembolization (TARE) is increasingly used as an alternative to transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). We aimed to perform an overall and individual patient data (IPD) meta-analysis of studies comparing TACE and TARE.

Methods: We performed a systematic literature search using pre-specified keywords with the aid of an informationist for articles from inception to 3/2020. The primary endpoint was overall survival (OS), and the secondary endpoint was time to progression (TTP).

Results: Seventeen studies met inclusion criteria with 2465 unique patients, with one randomized trial, 4 prospective studies and 12 retrospective studies. Barcelona Clinic Liver Cancer (BCLC) stage B (42.8%) was the most common stage followed by BCLC A (30.3%) and BCLC C (29.0%). There was no difference in OS between the two modalities (-0.55 months, 95% CI -1.95 to 3.05). In three studies with available TTP data, TARE resulted in a longer TTP than TACE (mean TTP 17.5 vs. 9.8 months; mean TTP difference 4.8 months, 95% CI 1.3-8.3 months). IPD-level meta-analysis of 311 patients from three studies showed no difference in overall OS between the two modalities including among subgroups stratified by tumor stage and liver function. Limitations of the current literature include inconsistent length of follow-up, inconsistency in response criteria, and safety reporting.

Conclusions: Current data suggest TARE provides significantly longer TTP than TACE, although the two treatments do not significantly differ in terms of OS. Given limitations of the current data, there is rationale for prospective studies comparing these modalities.

Keywords: HCC; TACE; Y-90; locoregional therapy.

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Conflict of interest statement

Brown: None. Kassab: None. Massani: None. Townsend: None. Singal: Served as a consultant or on advisory boards for Bayer, FujiFilm Wako Diagnostics, Exact Sciences, Roche, Glycotest, and GRAIL. Soydal: None. Moreno‐Luna: None. Roberts: Consults for AstraZeneca, MJH Life Sciences, and Clinical care options; he advises and received grants from Bayer, Exact Sciences, and Gilead; he advises GRAIL, Tavec, QED Therapeutics, Genentech, Envision, and Eisai and received grants from Ariad, BTG International, GylcoTest, RedHill, Ltd Pharma, and Wako Diagnostics. Chen: None. Parikh: Served as a consultant for Bristol Myers‐Squibb, Exact Sciences, Eli Lilly, and Freenome; has served on advisory boards of Genentech, Eisai, Bayer, Exelixis, Wako/Fujifilm; and has received research funding from Bayer, Target RWE, Exact Sciences, Genentech and Glycotest.

Figures

FIGURE 1
FIGURE 1
Forest plot of mean overall survival for transarterial chemoembolization (TACE) vs transarterial radioembolization (TARE). RE, random effects
FIGURE 2
FIGURE 2
Forest plot of mean time to progression for transarterial chemoembolization (TACE) vs transarterial radioembolization (TARE). RE, random effects
FIGURE 3
FIGURE 3
Individual‐level meta‐analysis forest plots for (A) Barcelona Clinic Liver Cancer stage (BCLC) A, (B) B, (C) C; (D) overall. Hazard ratio <1 implies TARE is favored and >1 implies TACE is favored. RE, random effects; TACE, transarterial chemoembolization; TARE, transarterial radioembolization
FIGURE 4
FIGURE 4
Individual‐level meta‐analysis forest plots for (A) Child Pugh A, (B) Child Pugh B, (C) overall. Hazard ratio <1 implies TARE is favored and >1 implies TACE is favored. RE, random effects. TACE, transarterial chemoembolization. TARE, transarterial radioembolization
See this image and copyright information in PMC

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