Tumor Necrosis in Conventional Versus Drug-Eluting Bead Transarterial Chemoembolization for HCC

CIO included several featured abstracts, and we had the opportunity to talk in more detail with the authors.

Abstract authors: E. Fayazzadeh, A.H. Amer, F. Aucejo, G. McLennan

What sparked your interest in comparing outcomes of conventional transarterial chemoembolization (cTACE) and TACE using drug-eluting beads (DEB-TACE), and what sets your study apart from what is already in the literature?

Drs. Fayazzadeh and McLennan: Despite the theoretical advantages of DEB-TACE and its promising results in earlier studies, the superiority of this modality over the conventional (ethiodized oil-based) method in terms of effectiveness is still in question. Most studies have used imaging as the primary tool for the assessment of tumor response to treatment. Our earlier study (DDI 2017) showed that there is not a very strong correlation between the imaging response and the actual tumor necrosis in pathological examination of liver explants. However, the current evidence using pathologic response as a factor for investigation is very scarce in the literature. This led us to focus on the pathological (rather than imaging) outcomes of the treatment in patients with early-to-moderate stage hepatocellular carcinoma (HCC) receiving TACE before liver transplantation.

Can you briefly describe the findings from your study?

Drs. Fayazzadeh and McLennan:  We found no significant difference in the percentage of actual tumor necrosis between cTACE (78%) and DEB-TACE (71%) groups. Eighty-seven percent of the patients in the cTACE group and 81% of the patients in the DEB-TACE group had complete or partial response to treatment in the pathological examination of liver explants. This difference between the groups was still NOT significant.

Tell me about something surprising you encountered while doing this research.

Drs. Fayazzadeh and McLennan: The discrepancy between radiologic response and pathological response was much greater than we thought it would be. Also, while the differences between DEB-TACE and cTACE were not that surprising, the similar pathological response does not necessarily correlate with the clinical response we see (increased pain and nausea with cTACE).

How might your findings eventually affect clinical practice?

Drs. Fayazzadeh and McLennan:  Unlike the current trend in favor of DEB-TACE, tumor response to treatment may not be a factor in determining the modality of choice for HCC TACE.

What future studies would you like to see take place?

Drs. Fayazzadeh and McLennan:  Possible patient dropouts from transplant list due to TACE is another factor to consider. Moreover, this study was a single-center retrospective review of a limited number of patients over a decade-long sequential timeline. Multicenter randomized controlled trials are strongly encouraged to validate our results.

What are you hoping that attendees take away from your presentation?

Drs. Fayazzadeh and McLennan: The pathologic response to treatment may be more reflective of what is going on in the liver than imaging response. A better understanding of what is happening pathologically is needed to understand the clinical responses we get, both in tumor progression and clinical adverse events.

In the patients receiving TACE as a bridging to liver transplant, either modality may be interchangeably used for tumor downstaging or growth delaying. To determine the better modality, the patient’s condition and the potential for adverse systemic/hepatic effects should be considered on an individual basis.