Biolato M, Pompili M. Dexamethasone and N-acetylcysteine before transarterial chemoembolization in hepatocellular carcinoma: A Western perspective. World J Gastroenterol 2024; 30(31): 3635-3639 [DOI: 10.3748/wjg.v30.i31.3635]
Corresponding Author of This Article
Marco Biolato, MD, PhD, Staff Physician, Department of Medical and Surgical Sciences, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy. marco.biolato@policlinicogemelli.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastroenterol. Aug 21, 2024; 30(31): 3635-3639 Published online Aug 21, 2024. doi: 10.3748/wjg.v30.i31.3635
Dexamethasone and N-acetylcysteine before transarterial chemoembolization in hepatocellular carcinoma: A Western perspective
Marco Biolato, Maurizio Pompili
Marco Biolato, Maurizio Pompili, Department of Medical and Surgical Sciences, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Marco Biolato, Maurizio Pompili, Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Lazio, Italy
Author contributions: Biolato M wrote the paper; Pompili M revised the manuscript with an important intellectual contribution; All authors have read and approved the final manuscript.
Conflict-of-interest statement: Dr. Biolato and Prof. Pompili have nothing to disclose.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Biolato, MD, PhD, Staff Physician, Department of Medical and Surgical Sciences, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy. marco.biolato@policlinicogemelli.it
Received: May 1, 2024 Revised: July 25, 2024 Accepted: July 29, 2024 Published online: August 21, 2024 Processing time: 103 Days and 21.8 Hours
Abstract
Post-embolization syndrome (PES) is the most common complication in patients with hepatocellular carcinoma treated with transarterial chemoembolization. Many strategies have been evaluated to reduce the incidence of PES, but no standard prevention guidelines currently exist. In a single-center, placebo-controlled trial, Simasingha et al evaluated the prophylactic administration of a combination of dexamethasone and N-acetylcysteine and documented a significant reduction in the incidence of PES (from 80% to 6%), of post-procedural liver decompensation (from 14% to 0%), and a shorter hospital stay (4 days vs 6 days), alongside an acceptable safety profile. The results of this study raise several controversial points regarding their applicability in the Western world. In the West, there is a greater and increasing prevalence of metabolic and alcoholic etiologies of liver cirrhosis, so a not negligible number of patients with type II diabetes or hypertension would be excluded from high-dosage dexamethasone prophylaxis. Furthermore, in the West, there is a preferred use of drug-eluting beads loaded with doxorubicin, which are associated with a lower incidence of PES. A study on prophylaxis with dexamethasone and/or N-acetylcysteine in a Western population is hopefully awaited.
Core Tip: Post-embolization syndrome is the most common complication of transarterial chemoembolization, which represents the most widespread treatment of hepatocellular carcinoma. In a single-center, placebo-controlled trial, Simasingha et al documented the efficacy and safety of the prophylactic administration of dexamethasone and N-Acetylcysteine in the prevention of post-embolization syndrome in these patients. The applicability of this prophylaxis in the Western world presents some concerns. In the West, there are important differences in the disease etiology, the drug used, and the use of microspheres, compared to the Eastern scenario. Furthermore, the use of dexamethasone presents risks that must be carefully evaluated in this population.
