New perspectives in hepatocellular carcinomaChemoembolization for Hepatocellular Carcinoma
Section snippets
Conventional TACE
HCC exhibits intense neo-angiogenic activity during its progression. The rationale for TACE is that the intra-arterial infusion of a drug such as doxorubicin or cisplatin with or without a viscous emulsion, followed by embolization of the blood vessel with gelatine sponge particles or other embolic agents, will result in a strong cytotoxic effect combined with ischemia.10 The survival benefit of transarterial embolization (TAE) or TACE has been the subject of a few randomized controlled trials
DEB-TACE
The ideal TACE scheme should allow maximum and sustained concentration of chemotherapeutic drug within the tumor with minimal systemic exposure combined with calibrated tumor vessel obstruction.10 The recent introduction of embolic microspheres that have the ability to actively sequester doxorubicin hydrochloride from solution and release it in a controlled and sustained fashion, has been shown to substantially diminish the amount of chemotherapy that reaches the systemic circulation compared
Response Assessment
Assessment of tumor response is of utmost importance in patients undergoing TACE.28 Unfortunately, conventional methods for response assessment, such as the Response Evaluation Criteria In Solid Tumors (RECIST) have limited predicting value in HCC patients treated with TACE.34, 35 These criteria rely only on tumor shrinkage as a measure of antitumor activity, an assumption that is only valid with cytotoxic drugs. TACE induces direct tumor necrosis and its anticancer efficacy is not paralleled
Synergies and Combination Strategies
An important limitation of any TACE regimen is the high rate of tumor recurrence. In RCTs, a sustained response lasting more than 3–6 months was observed in only 28%–35% of the patients who received conventionl TACE, and in nonresponders no survival benefit was identified compared to best supportive care.21, 22 Even in those patients in whom initial response was achieved, the 3-year cumulative rate of intrahepatic recurrence reached 65%, with recurrent tumor showing a significantly shorter
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Cited by (84)
Periodic mesoporous organosilica-coated magnetite nanoparticles combined with lipiodol for transcatheter arterial chemoembolization to inhibit the progression of liver cancer
2021, Journal of Colloid and Interface ScienceCitation Excerpt :TACE is a collaborative treatment process based on a combination of anticancer drugs and embolic agents [9,10]. The combination of doxorubicin (Dox) and lipiodol is the most widely used drug strategy for the treatment of HCC by TACE [11–13]. However, the effectiveness of the lipiodol system is limited by its rapid drug release characteristics [14–16].
Thermal Ablation and Transarterial Chemoembolization are Characterized by Changing Dynamics of Circulating MicroRNAs
2021, Journal of Vascular and Interventional RadiologyIn situ forming implants exposed to ultrasound enhance therapeutic efficacy in subcutaneous murine tumors
2020, Journal of Controlled ReleaseThe blooming intersection of transcatheter hepatic artery chemoembolization and nanomedicine
2020, Chinese Chemical LettersPredicting pharmacokinetic behaviour of drug release from drug-eluting embolization beads using in vitro elution methods
2019, European Journal of Pharmaceutical SciencesCitation Excerpt :More recently, we have described an open-loop flow through system which under the right conditions can be representative of the long-term release that has been observed for doxorubicin in explanted tissues (Swaine et al., 2016). None of these methods however, are particularly applicable to the initial 24 h post-delivery of the beads, where the peak plasma concentrations (Cmax) can be a predictor of the levels of systemic toxicity that might be experienced by the patient (Song & Kim, 2017; Lencioni, 2012). The reason for this lack of correlation is because established in vitro tests usually begin with a “pre-occluded system” in which the beads have already been placed into a situation that represents a post-administration occlusive mass (Caine et al., 2017a).
Prognostic Factors for Survival After Transarterial Chemoembolization Combined with Sorafenib in the Treatment of BCLC Stage B and C Hepatocellular Carcinomas
2018, Academic RadiologyCitation Excerpt :The rationale of TACE was based on the fact that tumor growth mostly depends on the blood supply from hepatic artery in HCC patients (26). However, previous studies had shown that the incomplete necrosis rate of the target tumor after the TACE procedure had reached 80%–90% (27–29). The overexpression of hypoxia inducible factor-1 after TACE treatment can obviously enhance the expression level of VEGF and finally results in the proliferation of tumor cells (30,31).
Conflicts of interest: none.