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Review
. 2023 May 15;13(5):1623-1639.
eCollection 2023.

Enhancement of treatment efficacy of hepatic tumours using Trans-arterial-chemoembolization

Krishna Pillai  1 , Kevin Ke  1 , Ahmed Mekkawy  1 , Javed Akhter  1 , David L Morris  1
Affiliations
Review

Enhancement of treatment efficacy of hepatic tumours using Trans-arterial-chemoembolization

Krishna Pillai et al. Am J Cancer Res. .

Abstract

This review article examines the basic principle underlying trans-arterial chemoembolization (TACE) used for treating unrespectable liver cancer with discussion on the barriers that are present for efficient drug delivery with suggestions on methods that may be used to overcome these barriers and hence enhance the efficacy of the technique. Current drugs used with TACE along with inhibitors of neovascularisation are briefly discussed. It also compares the conventional method of chemoembolization with TACE and rationalizes why there is not much of a difference between the two methods on treatment efficacy. Further it also suggests alternative methods of drug delivery that may be used instead of TACE. Additionally, it discusses the disadvantages on using non degradable microspheres with recommendations for degradable microspheres within 24 hours to overcome rebound neovascularisation owing to hypoxia. Finally, the review examines some of the biomarkers that are used to assess treatment efficacy with indication that non-invasive and sensitive biomarkers should be identified for routine screening and early detection. The review concludes that, if the current barriers present in TACE can be overcome along with the use of degradable microspheres and efficient biomarkers for monitoring efficacy, then a more robust treatment would emerge that may even serve as a cure.

Keywords: Sorafenib; Transarterial-chemoembolization; biomarkers; hepatic cellular carcinoma; microspheres; neo-vascularisation.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
It is a diagrammatic representation of enhanced clearance with build-up of Intra-tumoral fluid pressure. Mark 1 Indicates direction of blood flow in the blood vessels; Mark 2 Direction of drug diffusion; Mark 3 drugs escaping to newly formed blood capillaries. ITFP = Intra-tumoral fluid pressure.
Figure 2
Figure 2
Barriers to drug penetration and efficacy with possible methods to surmount them to increase the efficacy of TACE. ECM: extracellular matrix; HCC: Hepatic cellular carcinoma; TACE: trans-arterial-chemoembolization; VEGF: vascular epidermal growth factors.
Figure 3
Figure 3
Demonstrates the principals involved in intra-tumoral drug delivery system. ITFP: intratumoural fluid pressure.
Figure 4
Figure 4
Shows some of the common biomarkers that are detected in HCC for diagnostic and therapeutic purpose.
Figure 5
Figure 5
TACE as an ideal treatment for non-resectable HCC.
See this image and copyright information in PMC

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