Transarterial chemoembolization and sorafenib in hepatocellular carcinoma

Abstract

Transarterial chemoembolization (TACE) is considered as the standard therapy for patients with intermediate-stage hepatocellular carcinoma. However, given the high heterogeneity of this population, no common strategy or protocol standardization has been defined yet. In the last few years TACE treatment has been combined with sorafenib systemic therapy, reporting overall positive results both in terms of safety and efficacy. This systematic review presents and critically discusses the evidence available on the use of TACE in combination (concomitant or sequential) with sorafenib, focusing also on clinical trials currently ongoing to better define an optimal therapeutic strategy for this group of patients.

Keywords::

• combination therapy
• HCC
• intermediate stage
• sorafenib
• TACE

Financial & competing interests disclosure

Editorial assistance for the preparation of this manuscript was provided by Luca Giacomelli and Ambra Corti and was supported by Bayer Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Transarterial chemoembolization (TACE) is the standard locoregional therapy for patients with intermediate-stage hepatocellular carcinoma (HCC), while sorafenib is the only drug approved as systemic therapy in HCC patients.

• Patients classified as intermediate-stage HCC present highly heterogenic features; no standard treatment for this population has been defined yet, and a tailored approach is required to optimize the clinical outcome.

• A number of studies investigated the concomitant combination of TACE and sorafenib in intermediate- and advanced-stage HCC patients, reporting overall positive results in terms of overall survival and time to progression.

• Studies on the sequential treatment of TACE and sorafenib reported controversial results.

• The combination of drug-eluting beads-TACE and sorafenib has been reported to be safe and effective in treating intermediate- or advanced-stage HCC patients.

• The combination of TACE and sorafenib has been investigated also in real-life clinical practice, reporting an improvement in overall survival and time to progression.

• The addition of sorafenib to TACE therapy could help overcome the activation of proangiogenic factors that result from noncompletely effective TACE therapy. The antiangiogenic activity of sorafenib may help delay tumor progression, improving clinical outcome for HCC patients.

• Further studies are needed to better investigate the combination of TACE and sorafenib in terms of safety and efficacy and in particular to define the optimal timing of these therapies to better understand which population could benefit more from this type of treatment.

Notes