Chemoembolization plus radiotherapy improve liver cancer survival

Last Updated: 2018-03-26

By David Douglas

NEW YORK (Reuters Health) - In patients with hepatocellular carcinoma with macroscopic vascular invasion, treatment with transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) improves survival compared with sorafenib therapy, according to South Korean researchers.

"Our study may have significance as a first-ever randomized trial that demonstrates a treatment strategy showing a significant improvement in overall survival over sorafenib," Dr. Young-Suk Lim, told Reuters Health by email.

"During the last 10 years," he added, "all phase 3 trials assessing first-line therapies in advanced hepatocellular carcinoma have failed to improve overall patient survival over sorafenib."

In a paper online March 15 in JAMA Oncology, Dr. Lim and colleagues at the University of Ulsan College of Medicine in Seoul note that sorafenib, the current standard systemic treatment, has considerable limitations. However, observational studies have suggested more benefit with TACE plus RT.

To investigate, the team randomized 90 patients to sorafenib 400 mg twice daily or TACE every six weeks plus RT within three weeks of the first TACE. The patients' median age was 55 years and 77 were men. Their median maximal tumor diameter was 9.7 cm and most patients (78.9%) had multiple lesions.

At 12 weeks, progression-free survival was much higher in the TACE-RT group than in those given sorafenib (86.7% vs. 34.3%, P<0.001). Overall survival TACE-RT group was 55 weeks, compared to 43 weeks with sorafenib (P=0.04).

There was also a significantly higher radiologic response rate at 24 weeks (33.3% vs. 2.2%).

The researchers conclude, "Further studies are needed to confirm our findings and, given the poor overall patient survival even with TACE plus RT, to further improve patient outcome."

Dr. Khashayar Farsad, co-author of an accompanying editorial, told Reuters Health by email that the study "provides valuable prospective data supporting a role for targeted liver-directed therapy in advanced hepatocellular carcinoma."

"Moreover," said Dr. Farsad of Oregon Health and Science University in Portland, "the study highlights an evolving trend toward multimodality therapy to best treat this challenging disease."

SOURCE: https://bit.ly/2IS725F and https://bit.ly/2G7kuVB

JAMA Oncol 2018.