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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2020; 26(3): 324-334
Published online Jan 21, 2020. doi: 10.3748/wjg.v26.i3.324
Idarubicin vs doxorubicin in transarterial chemoembolization of intermediate stage hepatocellular carcinoma
Gaël Stéphane Roth, Yann Teyssier, Mélodie Abousalihac, Arnaud Seigneurin, Julien Ghelfi, Christian Sengel, Thomas Decaens
Gaël Stéphane Roth, Mélodie Abousalihac, Thomas Decaens, Clinique Universitaire d’Hépato-Gastroentérologie et Oncologie Digestive, CHU Grenoble-Alpes, Grenoble 38043, France
Gaël Stéphane Roth, Yann Teyssier, Arnaud Seigneurin, Thomas Decaens, Faculté de Médicine, Université Grenoble-Alpes, Domaine de la Merci, La Tronche 38700, France
Gaël Stéphane Roth, Thomas Decaens, Institute for Advanced Biosciences - INSERM U1209/CNRS UMR 5309/Université Grenoble-Alpes, Site Santé - Allée des Alpes, La Tronche 38700, France
Yann Teyssier, Julien Ghelfi, Christian Sengel, Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, Grenoble 38043, France
Arnaud Seigneurin, Département de Santé Publique - CHU Grenoble-Alpes, Grenoble 38043, France
Thomas Decaens, Department of Hepatology and Gastroenterology, Grenoble-Alpes University Hospital, Grenoble 38043, France
Author contributions: Roth GS and Decaens T contributed to study design, data collection, analyses, writing, and revision; Teyssier Y contributed to data collection and radiological independent analyses; Abousalihac A and Sengel C contributed to data collection; Seigneurin A contributed to statistics analyses; Ghelfi J contributed to writing and revision; Teyssier Y and Abousalihac M equally contributed to this work.
Institutional review board statement: Study ethics were approved by an independent institutional review board of CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand.
Informed consent statement: Patients gave their written consent before TACE procedures. No specific consent statement was required regarding the retrospective analysis of data as they were anonymously used.
Conflict-of-interest statement: Authors did not declare any conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Thomas Decaens, MD, PhD, Full Professor, Department of Hepatology and Gastroenterology, Grenoble-Alpes University Hospital, BP 217, Cedex 09, Grenoble 38043, France.
tdecaens@chu-grenoble.fr
Received: October 7, 2019
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
BACKGROUND
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.
AIM
To compare the objective response rate of idarubicin-based TACE (Ida-TACE) against doxorubicin-based TACE (Dox-TACE) in intermediate stage HCC.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
