Transarterial chemoembolization plus vitamin K enhances anticancer effects on HCC

Key takeaways:

• Transarterial chemoembolization plus vitamin K prolonged progression-free survival compared with TACE alone (262 days vs. 146 days).
• The combination therapy also suppressed des-gamma-carboxy prothrombin levels.

BOSTON — Transarterial chemoembolization with vitamin K dosing improved anticancer outcomes of objective response and progression-free survival in patients with hepatocellular carcinoma, according to a researcher at The Liver Meeting.

“We have previously reported that vitamin K dosing augments the anticancer action of sorafenib by suppressing levels of des-gamma-carboxy prothrombin, a known tumor growth and angiogenesis factor produced in HCC under sorafenib-induced ischemia,” Yoshimichi Haruna, MD, from Osaka General Medical Center in Japan, said during his presentation.

Seeking to establish whether vitamin K dosing could afford a similar anticancer effect when combined with transarterial chemoembolization (TACE), Haruna and colleagues conducted a prospective, open-label trial of 101 patients with unresectable HCC.

Patients were randomly assigned to TACE plus vitamin K 15 mg three times a day, from the day of procedure to day 28 (n = 50), or to TACE alone (n = 51).

The study’s primary endpoints were objective response rate and progression-free survival, and safety was a secondary endpoint.

According to study results, patients who underwent TACE plus vitamin K had a significantly higher objective response rate compared with those who underwent TACE alone (96% vs. 82.4%). Additionally, progression-free survival was longer in the TACE plus vitamin K group (median time, 262 days vs. 146 days; HR = 0.55; 95% CI, 0.34-0.89).

Further, results from a subgroup analysis showed vitamin K significantly prolonged progression-free survival, especially among women or those with high baseline serum des-gamma-carboxy prothrombin (DCP) levels (median, 369 days vs. 113 days; HR = 0.26).

Researchers also examined incidence of rapid and crucial recurrence 120 days after TACE, Haruna said, and recurrent events were more frequently observed with TACE alone vs. TACE plus vitamin K (14 vs. 4). However, the incidence of adverse events was not significantly different between the two groups.

“Vitamin K dosing combined with TACE suppressed DCP levels and enhanced the TACE-mediated anticancer action, as similarly shown in the vitamin K dosing combined with sorafenib treatment,” Haruna concluded. “Vitamin K dosing may be valuable when combined with other anticancer treatments for HCC.”