Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 3/2019

01-03-2019 | Interventional

TACE with degradable starch microspheres (DSM-TACE) as second-line treatment in HCC patients dismissing or ineligible for sorafenib

Authors: Roberto Iezzi, Maurizio Pompili, Emanuele Rinninella, Eleonora Annicchiarico, Matteo Garcovich, Lucia Cerrito, Francesca Ponziani, AnnaMaria De Gaetano, Massimo Siciliano, Michele Basso, Maria Assunta Zocco, GianLodovico Rapaccini, Alessandro Posa, Francesca Carchesio, Marco Biolato, Felice Giuliante, Antonio Gasbarrini, Riccardo Manfredi, the HepatoCatt Study Group

Published in: European Radiology | Issue 3/2019

Login to get access

Abstract

Objectives

To date, there is no approved second-line treatment for patients dismissing sorafenib or ineligible for this treatment, so it would be useful to find an effective alternative treatment option. The aim of our study was to evaluate safety, feasibility and effectiveness of transarterial chemoembolisation with degradable starch microspheres (DSM-TACE) in the treatment of patients with advanced hepatocellular carcinoma (HCC) dismissing or ineligible for multikinase-inhibitor chemotherapy administration (sorafenib) due to unbearable side effects or clinical contraindications.

Methods

Forty consecutive BCLC stage B or C patients (31 male; age, 70.6 ± 13.6 years), with intermediate or locally advanced HCC dismissing or ineligible for sorafenib administration, who underwent DSM-TACE treatment cycle via lobar approach were prospectively enrolled. Tumour response was evaluated on multidetector computed tomography based on mRECIST criteria. Primary endpoints were safety, tolerance and overall disease control (ODC); secondary endpoints were progression-free survival (PFS) and overall survival (OS).

Results

Technical success was achieved in all patients. No intra/peri-procedural death/major complications occurred. No signs of liver failure or systemic toxicity were detected. At 1-year follow-up, ODC of 52.5% was registered. PFS was 6.4 months with a median OS of 11.3 months.

Conclusions

DSM-TACE is safe and effective as a second-line treatment in HCC patients dismissing or ineligible for sorafenib.

Key Points

• DSM-TACE is safe and effective as second-line treatment in HCC patients dismissing or ineligible for sorafenib
• DSM-TACE allows the temporary occlusion of the smaller arterial vessels, improving overall therapeutic effectiveness by reducing the immediate wash-out of the cytostatic agent
• DSM-TACE also decreases the risk of systemic toxicity and post-embolic syndrome
Literature
1.
Rinninella E, Zocco MA, De Gaetano A et al (2012) From small nodule to overt HCC: a multistep process of carcinogenesis as seen during surveillance. Eur Rev Med Pharmacol Sci 16:1292–1294PubMed
2.
3.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90CrossRef
4.
Llovet JM, Brú C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338CrossRef
5.
Falkson G, MacIntyre JM, Moertel CG, Johnson LA, Scherman RC (1984) Primary liver cancer. An Eastern Cooperative Oncology Group Trial. Cancer 54:970–977PubMed
6.
Cabibbo G, Enea M, Attanasio M, Bruix J, Craxì A, Cammà C (2010) A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma. Hepatology 51:1274–1283CrossRefPubMed
7.
Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390CrossRef
8.
Cheng AL, Kang YK, Chen Z et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34CrossRef
9.
Italian Association for the Study of the Liver (AISF); AISF Expert Panel; AISF Coordinating Committee, Bolondi L, Cillo U, Colombo M et al (2013) Position paper of the Italian Association for the Study of the Liver (AISF): the multidisciplinary clinical approach to hepatocellular carcinoma. Dig Liver Dis 45:712–723CrossRef
10.
Iavarone M, Cabibbo G, Piscaglia F et al (2011) Field-practice study of sorafenib therapy for hepatocellular carcinoma: a prospective multicenter study in Italy. Hepatology 54:2055–2063CrossRefPubMed
11.
Ponziani FR, Bhoori S, Germini A et al (2016) Inducing tolerability of adverse events increases sorafenib exposure and optimizes patient's outcome in advanced hepatocellular carcinoma. Liver Int 36:1033–1042CrossRefPubMed
12.
Niessen C, Unterpaintner E, Goessmann H et al (2014) Degradable starch microspheres versus ethidol and doxorubicin in transarterial chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 25:240–247CrossRefPubMed
13.
Yamasaki T, Hamabe S, Saeki I et al (2011) A novel transcatheter arterial infusion chemotherapy using iodized oil and degradable starch microspheres for hepatocellular carcinoma: a prospective randomized trial. J Gastroenterol 46:359–366CrossRefPubMed
14.
Iezzi R, Pompili M, Nestola M et al (2016) Transarterial chemoembolization with degradable starch microspheres (DSM-TACE): an alternative option for advanced HCC patients? Preliminary results. Eur Rev Med Pharmacol Sci 20:2872–2877PubMed
15.
Schicho A, Pereira PL, Haimerl M et al (2017) Transarterial chemoembolization (TACE) with degradable starch microspheres (DSM) in hepatocellular carcinoma (HCC): multi-center results on safety and efficacy. Oncotarget 8:72613–72620CrossRefPubMedPubMedCentral
16.
Kudo M, Izumi N, Kokudo N et al (2011) HCC Expert Panel of Japan Society of Hepatology. Management of hepatocellular carcinoma in Japan: Consensus-Based Clinical Practice Guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis 29:339–364CrossRefPubMed
17.
Kudo M, Matsui O, Izumi N et al (2014) Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update. Oncology 87:22–31CrossRef
18.
Ikai I, Kudo M, Arii S et al (2010) Report of the 18th follow-up survey of primary liver cancer in Japan. Hepatol Res 40:1043–1059CrossRef
19.
Costentin CE, Ferrone CR, Arellano RS, Ganguli S, Hong TS, Zhu AX (2017) Hepatocellular carcinoma with macrovascular invasion: defining the optimal treatment strategy. Liver Cancer 6:360–374CrossRefPubMedPubMedCentral
20.
Basile A, Carrafiello G, Ierardi AM, Tsetis D, Brountzos E (2012) Quality-improvement guidelines for hepatic transarterial chemoembolization. Cardiovasc Intervent Radiol 35:765–774CrossRefPubMed
21.
Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236CrossRef
22.
Cholongitas E, Papatheodoridis GV, Vangeli M, Terreni N, Patch D, Burroughs AK (2005) Systematic review: The model for end-stage liver disease–should it replace Child-Pugh's classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther 22:1079–1089
23.
Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRef
24.
Terashima T, Yamashita T, Arai K et al (2014) Feasibility and efficacy of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma after sorafenib. Hepatol Res 44:1179–1185
25.
Finn RS, Kang YK, Mulcahy M et al (2012) Phase II, open-label study of brivanib as second-line therapy in patients with advanced hepatocellular carcinoma. Clin Cancer Res 18:2090–2098CrossRefPubMed
26.
Santoro A, Rimassa L, Borbath I et al (2013) Tivantinib for second-line treatment of advanced hepatocellular carcinoma: a randomized, placebo-controlled phase 2 study. Lancet Oncol 14:55–63CrossRefPubMed
27.
Yau T, Wong H, Chan P et al (2012) Phase II study of bevacizumab and erlotinib in the treatment of advanced hepatocellular carcinoma patients with sorafenib-refractory disease. Invest New Drugs 30:2384–2390CrossRefPubMedPubMedCentral
28.
Bruix J, Qin S, Merle P et al (2017) Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 389:56–66CrossRefPubMed
29.
El-Khoueiry AB, Sangro B, Yau T et al (2017) Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet 389:2492–2502CrossRef
30.
Wiggermann P, Wohlgemuth WA, Heibl M et al (2013) Dynamic evaluation and quantification of microvascularization during degradable starch microspheres transarterial Chemoembolisation (DSM-TACE) of HCC lesions using contrast enhanced ultrasound (CEUS): a feasibility study. Clin Hemorheol Microcirc 53:337–348PubMed
31.
European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer (2012) EASL–EORTC Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRef
32.
Giannini EG, Bucci L, Garuti F et al (2018) Patients with advanced hepatocellular carcinoma need a personalized management: A lesson from clinical practice. Hepatology 67(5):1784–1796CrossRefPubMed
33.
Bruix J, Llovet JM (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35:519–524CrossRefPubMed
34.
Greten TF, Papendorf F, Bleck JS et al (2005) Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients. Br J Cancer 92:1862–1868CrossRefPubMedPubMedCentral
Metadata
Title
TACE with degradable starch microspheres (DSM-TACE) as second-line treatment in HCC patients dismissing or ineligible for sorafenib
Authors
Roberto Iezzi
Maurizio Pompili
Emanuele Rinninella
Eleonora Annicchiarico
Matteo Garcovich
Lucia Cerrito
Francesca Ponziani
AnnaMaria De Gaetano
Massimo Siciliano
Michele Basso
Maria Assunta Zocco
GianLodovico Rapaccini
Alessandro Posa
Francesca Carchesio
Marco Biolato
Felice Giuliante
Antonio Gasbarrini
Riccardo Manfredi
the HepatoCatt Study Group
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5692-8

Other articles of this Issue 3/2019

European Radiology 3/2019 Go to the issue

Musculoskeletal

Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening

Neuro

Clinical significance of acute and chronic ischaemic lesions in multiple cerebral vascular territories

Ultrasound

Evaluation of liver parenchyma stiffness in patients with liver tumours: optimal strategy for shear wave elastography

Neuro

Significance of hyperintense arteries on Gd-enhanced 3D T1W black-blood imaging in acute stroke

Chest

Automated MR-based lung volume segmentation in population-based whole-body MR imaging: correlation with clinical characteristics, pulmonary function testing and obstructive lung disease

Oncology

68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study