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TAELE safer, more effective than TACE for HCC

Transarterial ethanol-lipiodol embolization was a safer and more effective technique for treating patients with hepatocellular carcinoma compared with conventional transarterial chemoembolization, according to study findings.

“In our study, [transarterial ethanol-lipiodol embolization (TAELE)] showed to be more effective in tumor devascularization and size-reduction, and less toxic than conventional [transarterial chemoembolization (cTACE)], with similar 1-month radiological outcomes … and similar 36-month survival,” the researchers wrote.

Researchers in Italy, including Francesco Somma, MD, of the department of interventional radiology at the National Cancer Institute "Fondazione Pascale”, randomly assigned 87 patients with intermediate HCC to be treated with either TAELE (n = 45; equal ratio of ethanol and lipiodol) or cTACE (n = 42; 50 mg epirubicin and 5 cc lipiodol). Follow-up was 36 months for all patients, and only one cTACE patient was lost after 35 months, according to the research.

Francesco Somma

Using a contrast-enhanced, multidetector computed tomography in dual phase acquisition, the researchers found no significant difference in the number of patients with partial and complete radiological tumor response between groups at 30 days after treatment according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). However, the researchers said patients treated with TAELE had a higher mean reduction in lesion size (P = .0003) and greater devascularization (P = .0004). More patients in the TAELE group also showed complete devascularization vs. the cTACE group (57.8% vs. 28.6%). Survival at 36 months was comparable between groups.

Abdominal pain and nausea were the most common grade 1 adverse events experienced by the patients. More patients in the cTACE group experienced these events compared with the TAELE group (47.6% vs. 26.6%). No deaths associated with either treatment were reported.

“Considering the onset of adverse events according to CTCAE version 4.0, TAETE is less invasive than cTATE,” Somma told Healio.com/Hepatology. “With regard to the adverse events due to liver parenchyma damage, the increase in serum total bilirubin and transaminases was greater after cTACE than after TAETE, with statistical significant differences.”

Somma further stated: ““Since TAELE grants similar radiological response according to mRECIST in the trans-arterial treatment of intermediate HCC with lower rate of adverse events, it is reasonable to prefer this cheaper and safer protocol to cTACE, which represents the standard of care for BCLC Stage B patients with HCC, at present.”

The researchers concluded in their study: “Compared to cTACE, TAELE showed a better toxicity profile with similar 36-month survival and similar 1-month antitumor effects, which makes it better tolerated by patients, especially in case of more than one treatment.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.