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
Transarterial chemoembolization (TACE) is the treatment of choice in intermediate hepatocellular carcinoma (HCC). Doxorubicin is largely used but without solid evidence in literature.
Growing research suggests that idarubicin is a serious candidate for use in TACE with one phase 1 clinical trial using lipiodol emulsion and a phase 1 as well as two phase 2 trials using drug-eluting beads. Idarubicin was never compared to doxorubicin in this setting. Because of multiple worldwide doxorubicin shortages, realization of TACE in patients with Barcelona Clinic Liver Cancer B becomes challenging and finding new alternatives to doxorubicin seems essential.
The objective of this study was to compare idarubicin-based TACE (Ida-TACE) with doxorubicin-based TACE (Dox-TACE) in the treatment of intermediate HCC in terms of anti-tumor efficacy and safety.
All patients undergoing TACE between January 2012 and December 2014 were screened and included with the following inclusion criteria: Child-Pugh score A or B, a performance status below or equal to 1, and no prior TACE. Lipiodol emulsion 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. Objective tumor response of TACE was assessed based on mRECIST criteria by independent radiologists. Progression-free survival and liver-transplant free survival were compared between groups using log-rank tests.
Both treatment group showed comparable characteristics. There were no differences in objective tumor response, progression-free survival, and liver-transplant free survival between Dox- and Ida-TACE. No additional toxicity was observed with idarubicin-TACE.
Idarubicin showed comparable efficacy and safety to doxorubicin in TACE and may represent a new option in the management of patients with Barcelona Clinic of Liver Cancer B HCC. In this study, due to the vast majority of patients treated by TACE using lipiodol, this constitutes the largest cohort of patients treated with idarubicin during TACE with delivery through lipiodol-emulsion.
Idarubicin represents a serious alternative to doxorubicin without complicating the procedure or increasing its toxicity. As lipiodol TACE is the most widespread technique to deliver chemotherapy, these results should easily help to improve HCC patient care worldwide. These results need to be confirmed by further clinical studies, and a phase II trial is scheduled.