Role of Transarterial Chemoembolization in the Treatment of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is the first-line recommendation for intermediate-stage HCC. In real-world clinical practice, TACE also plays an important role in early- and advanced-stage HCC. This review article by the experts from Chinese Liver Cancer Clinical Study Alliance (CHANCE) summarizes the available clinical evidence pertaining to the current application of TACE in patients with early-, intermediate-, and advanced-stage HCC. In addition, combination of TACE with other treatment modalities, especially immunotherapy, is reviewed.

Keywords: Hepatocellular carcinoma; Immunotherapy; TACE.

Fig. 1. Summary and comparison of the recommendations of TACE for HCC in different guidelines.

BCLC, Barcelona Clinic Liver Cancer; CNLC, China liver cancer; cTACE, conventional transarterial chemoembolization; DEB-TACE, drug-eluting bead transarterial chemoembolization; ECOG, Eastern Cooperative Oncology Group; HCC, hepatocellular carcinoma; JSH, Japan Society of Hepatology; NCCN, National Comprehensive Cancer Network; PVTT, portal vein tumor thrombosis; TACE, transarterial chemoembolization.

Fig. 2. Images obtained in patients with HCC treated with TACE.

A 73-year-old man had a history of chronic hepatitis B ≥20 years. The baseline CT showed a huge intrahepatic lesion without peritumoral star lesions or vascular invasion (red dotted circle). There is no extrahepatic spread. The patient was treated with DEB-TACE combined with oral donafenib (0.2 g). The 1- and 5-month follow-up MRI after DEB-TACE showed that the patient achieved a continued complete response. The patient is still being followed-up. CT, computed tomography; DEB-TACE, drug-eluting bead transarterial chemoembolization; HCC, hepatocellular carcinoma; MRI, magnetic resonance imaging; TACE, transarterial chemoembolization.

Fig. 3. Results of reported objective response rate of TACE for intermediate HCC.

BCLC, Barcelona Clinic Liver Cancer; HCC, hepatocellular carcinoma; ORR, objective response rate; TACE, transarterial chemoembolizarion.

Fig. 4. Possible mechanisms by which TACE and combination therapies provide benefit in HCC treatment.

HCC, hepatocellular carcinoma; HIF1α, hypoxia inducible factor-1 α; MDSC, myeloid-derived suppressor cell; PD1, programmed death 1; TACE, transarterial chemoembolization; VEGF, vascular endothelial growth factor.