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Comparison of drug-eluting beads pre-charged with doxorubicine (Deb-TACE) versus trans-arterial chemoembolization using polyethylene glycol drug-eluting beads pre-charged with idarubicin (Ida-TACE) in intermediate stage hepatocellular carcinoma: a propensity score matching phase I-II study

OBJECTIVE Transarterial chemoembolization (TACE) is the recommended treatment of intermediate hepatocellular carcinoma (HCC) according to BCLC statement. Doxorubicin is the most commonly used drug despite a low level of evidence. The objective of this study was to compare the feasibility and the objective response rate of idarubicin-based TACE (Ida-TACE) against doxorubicin-based TACE (Dox-TACE) in intermediate stage HCC.

METHODS A prospective study was conducted between March 2017 and February 2021 in one center including patients with indication for chemoembolization for intermediated HCC. Inclusion criteria were patients with ChildPugh score A or B, BCLC B or A (unsuitable for a cure) and no prior TACE. Drug-eluting beads selective TACE were performed with 10 mg of idarubicin charged with LifePearl (study group). A control group of patients treated by chemoembolization with 50-75 mg of doxorubicin charged with Dc-Beads was retrospectively selected to match to the study group. TACE response at 4-6 weeks, adverse events and overall survival was compared in the two groups.

RESULTS Twenty-three patients were included in the studied group and matched with twenty-three patients in a control group. There were 91% and 100% of alcoholic cirrhotic patients in the studied group and control group, respectively. The number of HCC treated per patient was 1.52 and 1.23 and the sum of nodule size treated was 38mm and 39mm for each group respectively. Objective response rate after first TACE was 74% and 78% (P = 0.54) and complete response 47.8% and 39.1% in studied group and control group, respectively. Safety profiles were similar in both groups. Overall survival was significantly better at 30 months for the studied group (P=0.005).

CONCLUSION Ida-TACE seems to be as safe as Dox-TACE but might be associated with a better overall survival at 30 months.

Rameau (langage normalisé) :
• Foie -- Cancer
  
• Carcinome hépatocellulaire
  
• Embolisation
  
• Microsphères (pharmacie)
  
• Doxorubicine
  
• Idarubicine