Abstract
Transarterial chemoembolization (TACE) is the current standard of care for patients
with intermediate-stage hepatocellular carcinoma (HCC) and relatively preserved liver
function. In a meta-analysis of randomized controlled trials comparing conventional
TACE regimens—including the administration of an anticancer-in-oil emulsion followed
by embolic agents—versus best supportive care, TACE was shown to improve median survival
from 16 to 20 months. Various strategies to improve outcomes for this patient group
have become the subject of much ongoing clinical research. The introduction of an
embolic drug-eluting bead (DEB) has been shown to substantially improve the pharmacokinetic
profile of TACE, providing levels of consistency and repeatability not available with
conventional regimens while concomitantly significantly diminishing systemic drug
exposure. In randomized trials, DEB-TACE significantly reduced liver toxicity and
drug-related adverse events compared with conventional TACE. In this article, technique,
indications and contraindications, and clinical outcomes of conventional and DEB-TACE
in the management of HCC are reviewed. In addition, scientific background and early
clinical experience with the use of combination regimens including TACE and systemically
active molecular-targeted agents with antiangiogenic properties are discussed. The
combination of DEB-TACE and antiangiogenic therapy represents a potentially powerful
approach that is currently undergoing clinical investigation in a phase 3 setting.
Keywords
chemoembolization - hepatocellular carcinoma - transcatheter therapy
