Hepatocellular carcinoma is a common malignant tumor of the digestive system . Despite significant advances in the diagnosis of early-stage liver cancer, patients with advanced liver cancer, including refractory liver cancer after hepatectomy, liver transplantation, and radiofrequency ablation, still account for more than 50% of the total.
In addition, patients who have undergone radical treatment still have a recurrence rate of up to 70% within 5 years, and many recurrence patients are unable to qualify for secondary surgery. Therefore, new treatments are urgently needed for these liver cancer patients.
TACE is the treatment of choice for inoperable intermediate-stage liver cancer
Transcatheter arterial chemo embolization (TACE) is the preferred and effective treatment for inoperable surgical resection of intermediate to advanced hepatocellular carcinoma.
TACE includes conventional TACE (conventional transcatheter arterial chemo embo-lization, CTACE) and drug-eluting microsphere TACE (drug-eluting beads transcatheter arterial chemo embolization, DEB-TACE) are two different chemotherapy approaches.
CTACE uses an embolic agent that is an emulsion of superfluid iodine oil and other chemotherapeutic agents, and the iodine oil carries the chemotherapeutic agent and is trapped inside the tumor cells to kill the tumor cells. However, conventional iodinated oil embolization is not sufficiently complete and may have the undesirable consequence of tumor recurrence.
So what is drug-loaded microsphere TACE? What are the advantages and features of TACE compared to CTACE?
What is drug-loaded microspheres?
What is drug-loaded microsphere TACE?
Drug-eluting beads (DEBs) are dry, non-toxic polymeric superabsorbent materials and are non-biodegradable particles down to 50 microns in size. It can absorb liquids and swell within minutes.
The drug-loaded microspheres are a novel material with both bolus and drug-loaded characteristics, allowing for sustained slow release of chemotherapy drugs, increasing local concentrations and decreasing systemic blood levels, making it an excellent chemotherapy bolus material for clinical applications.
DEB-TACE reduces side effects by adsorbing antitumor drugs and releasing chemotherapy drugs smoothly through microsphere drug loading mechanisms (mainly cation and anion group interactions and adsorption), allowing for the maintenance of high local blood concentrations in the tumor while lower systemic blood concentrations.
Which is better: conventional TACE or drug-loaded microsphere TACE?
TACE is good for patients.
It is well established that TACE is beneficial to patients, but the efficacy of the two different vehicles remains unclear.
The following study provides a meta-analysis of the efficacy of these two regimens, so let’s take a look.
Scientists screened 16 independent studies from 226 publications, including 4 randomized controlled trials, 3 prospective cohort studies, and 9 retrospective cohort studies. A total of 1832 patients were included, including 822 DEB-TACE-treated patients and 1010 CTACE-treated patients.
The results showed that overall survival at 1, 2, and 3 years was significantly higher in the DEB-TACE group than in the CTACE group, with an increase of 12%, 24%, and 69% in overall survival at each year, respectively.
There were also no statistically significant differences in adverse events (post-embolization syndrome and liver dysfunction) between the two groups.
The above results suggest that DEB-TACE treatment has a better survival benefit than CTACE treatment and provides a reliable basis for standardizing the treatment of clinical unresectable hepatocellular carcinoma.
Summary
DEB-TACE technology may play an important role in the treatment of advanced hepatocellular carcinoma, offering hope to patients with intermediate to advanced hepatocellular carcinoma, and is readily accepted by patients for its precision, less trauma, less pain, faster postoperative recovery, and higher drug cost-effectiveness.
However, DEB-TACE technology is still only a new trend in the future treatment of advanced liver cancer, and further studies are needed to confirm it in terms of disease control, postoperative complications, and combination drug use, which cannot yet be determined.
Also, DEB-TACE is currently indicated mainly for tumors in the liver, and further studies are needed to determine whether it can be applied to other cancer types.