Published online Jan 21, 2020. doi: 10.3748/wjg.v26.i3.324
Peer-review started: October 7, 2019
First decision: November 10, 2019
Revised: December 13, 2019
Accepted: December 21, 2019
Article in press: December 21, 2019
Published online: January 21, 2020
Processing time: 100 Days and 22.2 Hours
Liver cancer is the fifth most common cancer and the second cause of cancer-related deaths worldwide. Transarterial chemoembolization (TACE) is the best treatment of intermediate hepatocellular carcinoma (HCC). Doxorubicin is the most commonly used drug despite a low level of evidence.
To compare the objective response rate of idarubicin-based TACE (Ida-TACE) against doxorubicin-based TACE (Dox-TACE) in intermediate stage HCC.
Between January 2012 and December 2014, all patients treated with TACE at our academic hospital were screened. Inclusion criteria were patients with Child-Pugh score A or B, a performance status below or equal to 1, and no prior TACE. Either lipiodol TACE or drug-eluting beads TACE could be performed with 10 mg of idarubicin or 50 mg of doxorubicin. Each patient treated with idarubicin was matched with two doxorubicin-treated patients. The TACE response was assessed by independent radiologists according to the mRECIST criteria.
Sixty patients were treated with doxorubicin and thirty with idarubicin. There were 93% and 87% of cirrhotic patients and 87% and 70% of Child-Pugh A in the doxorubicin and idarubicin groups, respectively. The median number of HCC per patient was two in both groups with 31% and 26% of single nodules in doxorubicin and idarubicin groups, respectively. Objective response rate after first TACE was 76.7% and 73.3% (P = 0.797) with 41.7% and 40.0% complete response in doxorubicin and idarubicin groups, respectively. Progression-free survival was 7.7 mo in both groups, and liver transplant-free survival was 24.9 mo and 21.9 mo in doxorubicin and idarubicin groups, respectively. Safety profiles were similar in both groups, with grade 3-4 adverse events in 35% of Dox-TACE and 43% of Ida-TACEs.
Ida-TACE and Dox-TACE showed comparable results in terms of efficacy and safety. Ida-TACE may represent an interesting alternative to Dox-TACE in the management of patients with intermediate stage HCC.
Core tip: Transarterial chemoembolization in the treatment of choice for intermediate stage hepatocellular carcinoma. Doxorubicin is the most used drug without any satisfying evidence of its superiority compared with other drugs. An increasing number of preclinical and early phase clinical studies suggest the superiority of idarubicin anti-tumor efficacy in transarterial chemoembolization. With the limits relative to retrospective analysis, this study shows that idarubicin represents an alternative to doxorubicin in the treatment of hepatocellular carcinoma with comparable efficacy and safety. It needs to be confirmed by randomized clinical trials.