Liver Cancer最新文献

{"title":"Real Life Study of Lenvatinib Therapy for Hepatocellular Carcinoma: RELEVANT Study.","authors":"Andrea Casadei-Gardini, Margherita Rimini, Masatoshi Kudo, Shigeo Shimose, Toshifumi Tada, Goki Suda, Myung Ji Goh, Andre Jefremow, Mario Scartozzi, Giuseppe Cabibbo, Claudia Campani, Emiliano Tamburini, Francesco Tovoli, Kazuomi Ueshima, Tomoko Aoki, Hideki Iwamoto, Takuji Torimura, Takashi Kumada, Atsushi Hiraoka, Masanori Atsukawa, Ei Itobayashi, Hidenori Toyoda, Naoya Sakamoto, Takuya Sho, Wonseok Kang, Jürgen Siebler, Markus Friedrich Neurath, Valentina Burgio, Stefano Cascinu","doi":"10.1159/000525145","DOIUrl":"10.1159/000525145","url":null,"abstract":"<p><strong>Introduction: </strong>In the REFLECT trial, lenvatinib was found to be noninferior compared to sorafenib in terms of overall survival. Here, we analyze the effects of lenvatinib in the real-life experience of several centers across the world and identify clinical factors that could be significantly associated with survival outcomes.</p><p><strong>Methods: </strong>The study population was derived from retrospectively collected data of HCC patients treated with lenvatinib. The overall cohort included western and eastern populations from 23 center in five countries.</p><p><strong>Results: </strong>We included 1,325 patients with HCC and treated with lenvatinib in our analysis. Median OS was 16.1 months. Overall response rate was 38.5%. Multivariate analysis for OS highlighted that HBsAg positive, NLR >3, and AST >38 were independently associated with poor prognosis in all models. Conversely, NAFLD/NASH-related etiology was independently associated with good prognosis. Median progression-free survival was 6.3 months. Multivariate analysis for progression-free survival revealed that NAFLD/NASH, BCLC, NLR, and AST were independent prognostic factors for progression-free survival. A proportion of 75.2% of patients suffered from at least one adverse effect during the study period. Multivariate analysis exhibited the appearance of decreased appetite grade ≥2 versus grade 0-1 as an independent prognostic factor for worse progression-free survival. 924 patients of 1,325 progressed during lenvatinib (69.7%), and 827 of them had a follow-up over 2 months from the beginning of second-line treatment. From first-line therapy, the longest median OS was obtained with the sequence lenvatinib and immunotherapy (47.0 months), followed by TACE (24.7 months), ramucirumab (21.2 months), sorafenib (15.7 months), regorafenib (12.7 months), and best supportive care (10.8 months).</p><p><strong>Conclusions: </strong>Our study confirms in a large and global population of patients with advanced HCC, not candidates for locoregional treatment the OS reported in the registration study and a high response rate with lenvatinib.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 6","pages":"527-539"},"PeriodicalIF":11.6,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/11/lic-0011-0527.PMC9801178.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10458341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discriminatory Changes in Circulating Metabolites as a Predictor of Hepatocellular Cancer in Patients with Metabolic (Dysfunction) Associated Fatty Liver Disease.","authors":"Haonan Lu, Jacob George, Mohammed Eslam, Augusto Villanueva, Luigi Bolondi, Helen L Reeves, Misti McCain, Edward Chambers, Caroline Ward, Dewi Sartika, Caroline Sands, Lynn Maslen, Matthew R Lewis, Ramya Ramaswami, Rohini Sharma","doi":"10.1159/000525911","DOIUrl":"10.1159/000525911","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of metabolic (dysfunction) associated fatty liver disease (MAFLD) is rising mirrored by an increase in hepatocellular cancer (HCC). MAFLD and its sequelae are characterized by perturbations in lipid handling, inflammation, and mitochondrial damage. The profile of circulating lipid and small molecule metabolites with the development of HCC is poorly characterized in MAFLD and could be used in future studies as a biomarker for HCC.</p><p><strong>Methods: </strong>We assessed the profile of 273 lipid and small molecule metabolites by ultra-performance liquid chromatography coupled to high-resolution mass spectrometry in serum from patients with MAFLD (<i>n</i> = 113) and MAFLD-associated HCC (<i>n</i> = 144) from six different centers. Regression models were used to identify a predictive model of HCC.</p><p><strong>Results: </strong>Twenty lipid species and one metabolite, reflecting changes in mitochondrial function and sphingolipid metabolism, were associated with the presence of cancer on a background of MAFLD with high accuracy (AUC 0.789, 95% CI: 0.721-0.858), which was enhanced with the addition of cirrhosis to the model (AUC 0.855, 95% CI: 0.793-0.917). In particular, the presence of these metabolites was associated with cirrhosis in the MAFLD subgroup (<i>p</i> < 0.001). When considering the HCC cohort alone, the metabolic signature was an independent predictor of overall survival (HR 1.42, 95% CI: 1.09-1.83, <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>These exploratory findings reveal a metabolic signature in serum which is capable of accurately detecting the presence of HCC on a background of MAFLD. This unique serum signature will be taken forward for further investigation of diagnostic performance as biomarker of early stage HCC in patients with MAFLD in the future.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"12 1","pages":"19-31"},"PeriodicalIF":13.8,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/aa/fc/lic-0012-0019.PMC9982340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10853161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Front & Back Matter","authors":"","doi":"10.1159/000525876","DOIUrl":"https://doi.org/10.1159/000525876","url":null,"abstract":"","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"8 1","pages":""},"PeriodicalIF":13.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83816751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Cancer Study Group of Japan Clinical Practice Guidelines for Intrahepatic Cholangiocarcinoma.","authors":"Shoji Kubo,&nbsp;Hiroji Shinkawa,&nbsp;Yoshinari Asaoka,&nbsp;Tatsuya Ioka,&nbsp;Hiroshi Igaki,&nbsp;Namiki Izumi,&nbsp;Takao Itoi,&nbsp;Michiaki Unno,&nbsp;Masayuki Ohtsuka,&nbsp;Takuji Okusaka,&nbsp;Masumi Kadoya,&nbsp;Masatoshi Kudo,&nbsp;Takashi Kumada,&nbsp;Norihiro Kokudo,&nbsp;Michiie Sakamoto,&nbsp;Yoshihiro Sakamoto,&nbsp;Hideyuki Sakurai,&nbsp;Tadatoshi Takayama,&nbsp;Osamu Nakashima,&nbsp;Yasushi Nagata,&nbsp;Etsuro Hatano,&nbsp;Kenichi Harada,&nbsp;Takamichi Murakami,&nbsp;Masakazu Yamamoto","doi":"10.1159/000522403","DOIUrl":"https://doi.org/10.1159/000522403","url":null,"abstract":"<p><p>This paper presents the first version of clinical practice guidelines for intrahepatic cholangiocarcinoma (ICC) established by the Liver Cancer Study Group of Japan. These guidelines consist of 1 treatment algorithm, 5 background statements, 16 clinical questions, and 1 clinical topic, including etiology, staging, pathology, diagnosis, and treatments. Globally, a high incidence of ICC has been reported in East and Southeast Asian countries, and the incidence has been gradually increasing in Japan and also in Western countries. Reported risk factors for ICC include cirrhosis, hepatitis B/C, alcohol consumption, diabetes, obesity, smoking, nonalcoholic steatohepatitis, and liver fluke infestation, as well as biliary diseases, such as primary sclerosing cholangitis, hepatolithiasis, congenital cholangiectasis, and Caroli disease. Chemical risk factors include thorium-232, 1,2-dichloropropane, and dichloromethane. CA19-9 and CEA are recommended as tumor markers for early detection and diagnostic of ICC. Abdominal ultrasonography, CT, and MRI are effective imaging modalities for diagnosing ICC. If bile duct invasion is suspected, imaging modalities for examining the bile ducts may be useful. In unresectable cases, tumor biopsy should be considered when deemed necessary for the differential diagnosis and drug therapy selection. The mainstay of treatment for patients with Child-Pugh class A or B liver function is surgical resection and drug therapy. If the patient has no regional lymph node metastasis (LNM) and has a single tumor, resection is the treatment of choice. If both regional LNM and multiple tumors are present, drug therapy is the first treatment of choice. If the patient has either regional LNM or multiple tumors, resection or drug therapy is selected, depending on the extent of metastasis or the number of tumors. If distant metastasis is present, drug therapy is the treatment of choice. Percutaneous ablation therapy may be considered for patients who are ineligible for surgical resection or drug therapy due to decreased hepatic functional reserve or comorbidities. For unresectable ICC without extrahepatic metastasis, stereotactic radiotherapy (tumor size ≤5 cm) or particle radiotherapy (no size restriction) may be considered. ICC is generally not indicated for liver transplantation, and palliative care is recommended for patients with Child-Pugh class C liver function.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 4","pages":"290-314"},"PeriodicalIF":13.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/3d/lic-0011-0290.PMC9294959.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9359193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APPLE News","authors":"","doi":"10.1159/000525668","DOIUrl":"https://doi.org/10.1159/000525668","url":null,"abstract":"","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"38 1","pages":"398 - 398"},"PeriodicalIF":13.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82733863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Treatment of Advanced Unresectable Hepatocellular Carcinoma after First-Line Therapy: Expert Recommendations from Hong Kong, Singapore, and Taiwan.","authors":"Thomas Yau,&nbsp;David Tai,&nbsp;Stephen Lam Chan,&nbsp;Yi-Hsiang Huang,&nbsp;Su Pin Choo,&nbsp;Chiun Hsu,&nbsp;Tan To Cheung,&nbsp;Shi-Ming Lin,&nbsp;Wei Peng Yong,&nbsp;Joycelyn Lee,&nbsp;Thomas Leung,&nbsp;Tracy Shum,&nbsp;Cynthia S Y Yeung,&nbsp;Anna Yin-Ping Tai,&nbsp;Ada Lai Yau Law,&nbsp;Ann-Lii Cheng,&nbsp;Li-Tzong Chen","doi":"10.1159/000525582","DOIUrl":"https://doi.org/10.1159/000525582","url":null,"abstract":"<p><strong>Background: </strong>Asia has a high burden of hepatocellular carcinoma (HCC) due to the high rates of chronic hepatitis B infection and accounts for 70% of HCC cases globally. In the past 20 years, the systemic treatment landscape of advanced HCC has evolved substantially - from tyrosine kinase inhibitors to immune-oncology agents plus anti-vascular endothelial growth factor agents. The appropriate sequence of therapies has become critical in optimizing patient outcomes given the increase in systemic therapeutic options. This article evaluates the evidence and provides expert recommendations for the use of systemic therapies after first-line treatment in patients with advanced HCC.</p><p><strong>Summary: </strong>Based on three virtual meetings held in early 2021, a team of 17 experts comprising oncologists, a hepatologist, and a hepatobiliary surgeon from Hong Kong, Singapore, and Taiwan reviewed available data about systemic treatments for HCC after first line and formulated 28 statements. These statements aimed to provide expert guidance on selecting first and subsequent lines of therapies as well as recommending therapies in special circumstances, such as poor liver function, posttransplantation, recent gastrointestinal bleeding, or autoimmune diseases. Data supporting the statements were drawn from clinical trials and real-world studies. The 28 statements were then evaluated anonymously using a 5-point Likert scale, and 24 reached consensus, predefined as achieving 75% agreement. Statements generated covered the selection of first-line systemic therapy, considerations and goals of second-line systemic therapies, treatment selection following first-line therapy, and treatment recommendations following first-line tyrosine kinase inhibitors, immune-oncology monotherapy, or immune-oncology combination therapy. The authors also shared expert opinion on the use of second-line systemic therapy in patients with liver dysfunction, liver transplantation, and recent gastrointestinal or autoimmune disease.</p><p><strong>Key messages: </strong>These expert statements summarize the latest data and expert opinion on selecting systemic treatment following first-line therapy in patients with unresectable advanced or metastatic HCC.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 5","pages":"426-439"},"PeriodicalIF":13.8,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/55/lic-0011-0426.PMC9485972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres Followed by Gemcitabine plus Cisplatin for Unresectable Intrahepatic Cholangiocarcinoma: A Phase 2 Single-Arm Multicenter Clinical Trial.","authors":"Stephen Lam Chan,&nbsp;Chanisa Chotipanich,&nbsp;Su Pin Choo,&nbsp;Su Wen Kwang,&nbsp;Frankie Mo,&nbsp;Akeanong Worakitsitisatorn,&nbsp;David Tai,&nbsp;Raghav Sundar,&nbsp;David Chee Eng Ng,&nbsp;Kelvin Siu Hoong Loke,&nbsp;Leung Li,&nbsp;Kelvin Kwok Chai Ng,&nbsp;Yong Wei Peng,&nbsp;Simon Chun-Ho Yu","doi":"10.1159/000525489","DOIUrl":"https://doi.org/10.1159/000525489","url":null,"abstract":"<p><strong>Introduction: </strong>This investigator-initiated clinical trial aims to study the efficacy and safety of administering selective internal radiation therapy with resin yttrium-90 microspheres (SIRT) followed by standard chemotherapy in unresectable intrahepatic cholangiocarcinoma (ICC).</p><p><strong>Methods: </strong>A phase 2 single-arm multicenter study was conducted in patients with unresectable ICC (NCT02167711). SIRT was administered at dose of 120 Gy targeted at tumor followed by commencement of gemcitabine 1,000 mg/m² and cisplatin 25 mg/m² on days one and eight of a 21-day cycle. The primary endpoint was overall survival (OS), and the secondary endpoints include progression-free survival (PFS), response rate according to Response Evaluation Criteria in solid tumors 1.1, toxicity, and time from SIRT to commencement of chemotherapy.</p><p><strong>Results: </strong>Total 31 patients were screened and twenty-four were recruited. All patients completed SIRT and 16 of them underwent subsequent chemotherapy. The median cycle of chemotherapy was 5 (range: 1-8). The median OS was 13.6 months (95% CI: 5.4-21.6) for the intent-to-treat population. Among 16 patients undergoing chemotherapy, the median OS was 21.6 months (95% CI: 7.3-25.2) and the median PFS was 9 months (95% CI: 3.2-13.1). The response rate was 25% (95% CI: 3.8-46.2%), and the disease control rate was 75% (95% CI: 53.8-96.2%). No new safety signal was observed, with fewer than 10% of patients suffering from grade 3 or higher treatment-related adverse events. The median time from SIRT to chemotherapy was 29 (range: 7-42) days. Eight patients could not receive chemotherapy due to rapid progressive disease (<i>n</i> = 4), underlying treatment unrelated comorbidities (<i>n</i> = 2), and withdrawal of consent due to personal reasons (<i>n</i> = 2).</p><p><strong>Conclusions: </strong>Treatment of SIRT followed by standard gemcitabine and cisplatin chemotherapy is feasible and effective for unresectable ICC. Further studies are required to study the optimal sequence of SIRT and chemotherapy.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 5","pages":"451-459"},"PeriodicalIF":13.8,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/17/lic-0011-0451.PMC9485918.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure to Air Pollution and Survival in Follow-Up after Hepatocellular Carcinoma.","authors":"Wei-Shan Chin, Shin-Chun Pan, Ching-Chun Huang, Pei-Jer Chen, Yue Leon Guo","doi":"10.1159/000525346","DOIUrl":"10.1159/000525346","url":null,"abstract":"<p><strong>Introduction: </strong>Air pollutants are classified as carcinogens by the International Agency for Research on Cancer. Long-term exposure to ambient particulate matter with an aerodiameter of 2.5 μm or lower (PM_2.5) has been reported to be linked with increased mortality due to hepatocellular carcinoma (HCC). However, the effects of air pollutants other than PM_2.5 on HCC-related mortality have not been fully investigated. Accordingly, we conducted this study to assess the effect of long-term exposure to air pollutants (PM_2.5 and nitrogen dioxide [NO₂]) on HCC-related mortality.</p><p><strong>Method: </strong>In 2005, the Taiwan Liver Cancer Network (TLCN) was established by the National Research Program for Genomic Medicine to recruit liver cancer patients from 5 major medical centers in northern, central, and southern Taiwan. The TLCN had successfully recruited 9,344 patients by the end of 2018. In this study, we included 1,000 patients randomly sampled from the TLCN to assess the effect of exposure to air pollutants on HCC mortality after HCC diagnosis. Daily averages of PM_2.5 and NO₂ concentrations were retrieved from 77 air quality-monitoring stations and interpolated to the townships of patients' residences by using the Kriging method. The effect of air pollutants on HCC survival was assessed using a Cox proportional hazards model.</p><p><strong>Results: </strong>A total of 940 patients were included in the analysis. After adjusting for potential confounders and mutually adjusting for co-pollutants, we observed that the hazards ratio (95% confidence interval) for HCC-related mortality for every 1-μg/m³ increase in PM_2.5 concentration was 1.11 (1.08-1.14) and that for every 1-ppb increase in NO₂ concentration was 1.08 (1.03-1.13).</p><p><strong>Conclusion: </strong>Our study suggests that long-term exposure to PM_2.5 and NO₂ was associated with decreased survival time in patients with HCC in Taiwan.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 5","pages":"474-482"},"PeriodicalIF":11.6,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/40/lic-0011-0474.PMC9485987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional or Drug-Eluting Beads? Randomized Controlled Study of Chemoembolization for Hepatocellular Carcinoma: JIVROSG-1302.","authors":"Masafumi Ikeda,&nbsp;Yasuaki Arai,&nbsp;Yoshitaka Inaba,&nbsp;Toshihiro Tanaka,&nbsp;Shunsuke Sugawara,&nbsp;Yoshihisa Kodama,&nbsp;Takeshi Aramaki,&nbsp;Hiroshi Anai,&nbsp;Shinichi Morita,&nbsp;Yoshinori Tsukahara,&nbsp;Hiroshi Seki,&nbsp;Mikio Sato,&nbsp;Kenya Kamimura,&nbsp;Kimei Azama,&nbsp;Masakatsu Tsurusaki,&nbsp;Eiji Sugihara,&nbsp;Masaya Miyazaki,&nbsp;Tatsushi Kobayashi,&nbsp;Miyuki Sone","doi":"10.1159/000525500","DOIUrl":"https://doi.org/10.1159/000525500","url":null,"abstract":"<p><strong>Introduction: </strong>With the advent of effective systemic therapy, transarterial chemoembolization (TACE) is established as a highly effective locoregional treatment modality for carefully selected patients with hepatocellular carcinoma (HCC). This randomized controlled trial was conducted to clarify whether selective TACE with drug-eluting beads (DEB-TACE) loaded with epirubicin or selective conventional TACE (cTACE) with epirubicin-ethiodized oil might be more effective for obtaining complete response(CR) in patients with HCC.</p><p><strong>Methods: </strong>Between March 2016 and May 2019, Child-Pugh class A or B patients with unresectable HCC who were scheduled to receive selective TACE were randomly assigned at a 1:1 ratio to the DEB-TACE arm or the cTACE arm. The primary endpoint was the CR rate at 3 months, as evaluated according to the modified Response Evaluation Criteria in Solid Tumors by an independent review committee, and the secondary endpoints were the CR rate at 1 month and incidences of adverse events.</p><p><strong>Results: </strong>A total of 200 patients (DEB-TACE, 99 patients; cTACE, 101 patients) were enrolled in the study. The CR rates at 3 months and 1 month were significantly higher in the cTACE arm (75.2%, 84.2%) as compared with the DEB-TACE arm (27.6%, 35.7%). However, the frequencies of adverse events of any grade, including pyrexia (DEB-TACE vs. cTACE, 19.4% vs. 45.5%, <i>p</i> = 0.0001), fatigue (5.1% vs. 15.8%, <i>p</i> = 0.0194), malaise (11.1% vs. 25.7%, <i>p</i> = 0.0103), appetite loss (12.1% vs. 28.7%, <i>p</i> = 0.0048), abdominal pain (12.1% vs. 23.8%, <i>p</i> = 0.0423), increased serum bilirubin (22.2% vs. 48.5%, <i>p</i> = 0.0002), hypoalbuminemia (43.4% vs. 60.3%, <i>p</i> = 0.0154), increased serum aspartate aminotransferase (35.7% vs. 81.2%, <i>p</i> < 0.0001), and increased serum alanine aminotransferase (35.7% vs. 77.2%, <i>p</i> < 0.0001), were also significantly higher in the cTACE arm than in the DEB-TACE arm.</p><p><strong>Conclusions: </strong>Selective cTACE appeared to have higher CR rates for local tumor control as compared to selective DEB-TACE for HCC. However, the frequency of postembolization syndrome was also significantly higher in the cTACE group than in the DEB-TACE group. Thus, to achieve CR, cTACE may be selected over DEB-TACE in patients who can be expected to tolerate postembolization syndrome.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 5","pages":"440-450"},"PeriodicalIF":13.8,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/0e/lic-0011-0440.PMC9485929.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Treatments with Tyrosine Kinase Inhibitor and Platinum-Based Chemotherapy in Patients with Unresectable or Metastatic Hepatocholangiocarcinoma.","authors":"Elia Gigante,&nbsp;Christian Hobeika,&nbsp;Brigitte Le Bail,&nbsp;Valérie Paradis,&nbsp;David Tougeron,&nbsp;Marie Lequoy,&nbsp;Mohamed Bouattour,&nbsp;Jean-Frederic Blanc,&nbsp;Nathalie Ganne-Carrié,&nbsp;Henri Tran,&nbsp;Clémence Hollande,&nbsp;Manon Allaire,&nbsp;Giuliana Amaddeo,&nbsp;Hélène Regnault,&nbsp;Paul Vigneron,&nbsp;Maxime Ronot,&nbsp;Laure Elkrief,&nbsp;Gontran Verset,&nbsp;Eric Trepo,&nbsp;Aziz Zaanan,&nbsp;Marianne Ziol,&nbsp;Massih Ningarhari,&nbsp;Julien Calderaro,&nbsp;Julien Edeline,&nbsp;Jean-Charles Nault","doi":"10.1159/000525488","DOIUrl":"https://doi.org/10.1159/000525488","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>Even if no systemic treatment is currently validated for unresectable hepatocellular-cholangiocarcinoma (cHCC-CCA), tyrosine kinase inhibitors (TKIs) and platinum-based chemotherapy are frequently used in clinical practice. Our study aims to describe the effectiveness of first-line systemic treatments in patients with cHCC-CCA.</p><p><strong>Patients and methods: </strong>Patients with histological diagnosis of unresectable or metastatic cHCC-CCA confirmed by a centralized review (WHO classification 2019) and who received systemic treatment from 2009 to 2020 were included retrospectively in 11 centers. The outcomes of patients with cHCC-CCA were compared with patients with hepatocellular carcinoma (HCC) treated by sorafenib (<i>n</i> = 117) and with intrahepatic cholangiocarcinoma (iCCA, <i>n</i> = 94) treated mainly by platinum-based chemotherapy using a frailty Cox model. The efficacy of TKIs and platinum-based chemotherapies in patients with cHCC-CCA was assessed using a doubly robust estimator.</p><p><strong>Results: </strong>A total of 83 patients with cHCC-CCA were included and were predominantly male (72%) with underlying cirrhosis (55%). 67% of patients had extrahepatic metastases and 31% macrovascular tumor invasion. cHCC-CCAs were more often developed on cirrhosis (55.4%) than iCCA (26.6%) but less frequently than HCC (80.2%) (<i>p</i> < 0.001). Both HCC (36.8% and cHCC-CCA (66.2%) had less frequent extrahepatic metastases than iCCA (81%) (<i>p</i> < 0.001). Unadjusted overall survival (OS) was better in iCCA (13 months) compared to cHCC-CCA (12 months) and HCC (11 months) (<i>p</i> = 0.130). In multivariable analysis, after adjustment by a Cox frailty model, patients with cHCC-CCA had the same survival as HCC and iCCA (HR = 0.67, 95% CI: 0.37-1.22, <i>p</i> = 0.189 and HR = 0.66, 95% CI: 0.43-1.02, <i>p</i> = 0.064, respectively). ALBI score (HR = 2.15; 95% CI: 1.23-3.76; <i>p</i> = 0.009), ascites (HR = 3.45, 95% CI: 1.31-9.03, <i>p</i> = 0.013), and tobacco use (HR = 2.29, 95% CI: 1.08-4.87, <i>p</i> = 0.032) were independently associated with OS in patients with cHCC-CCA. Among patients with cHCC-CCA, 25 patients treated with TKI were compared with 54 patients who received platinum-based chemotherapies. Patients treated with TKI had a median OS of 8.3 months compared to 11.9 months for patients treated with platinum-based chemotherapy (<i>p</i> = 0.86). After a robust doubly adjustment on tumor number and size, vascular invasion, ALBI, MELD, and cirrhosis, the type of treatment did not impact OS (HR = 0.92, 95% CI: 0.27-3.15, <i>p</i> = 0.88) or progression-free survival (HR = 1.24, 95% CI: 0.44-3.49, <i>p</i> = 0.67).</p><p><strong>Conclusions: </strong>First-line systemic treatments with TKIs or platinum-based chemotherapies have similar efficacy in patients with unresectable/metastatic cHCC-CCA. The ALBI score predicts OS.</p>","PeriodicalId":18156,"journal":{"name":"Liver Cancer","volume":"11 5","pages":"460-473"},"PeriodicalIF":13.8,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/9b/lic-0011-0460.PMC9485952.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33484712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}