Conventional vs drug-eluting beads transarterial chemoembolization for hepatocellular carcinoma

Table 1 Clinical outcomes from studies comparing drug-eluting bead-transarterial chemoembolization and conventional transarterial chemoembolization in patients with intermediate-stage hepatocellular carcinoma

Ref.	Study design	Arm	BCLC stage n (A/B/C)	Clinical outcomes in intermediate-stage (BCLC-B) (DEB-TACE/cTACE)
				OS rate	P value	TTP	P value	Response rate	P value
Lammer et al[10]	RCT	DEB-TACE	24/69/0	NR		NR		OR 52.4%/34.7%2	0.038
		cTACE	29/79/0					DC 63.5%/44.4%2	0.026
Wiggermann et al[46]1	Retrospective	DEB-TACE	1/17/3	70%/55% (1-yr survival rate)	0.01	NR		OR 22.7%/22.7%3
		cTACE	4/15/2					DC 90.9%/68.2%3	0.066
Song et al[9]	Retrospective	DEB-TACE	27/33/0	DEB > cTACE (log-rank test)	0.020	DEB > cTACE (log-rank test)	0.038	OR 75.6%/34.1%4	< 0.001
		cTACE	28/41/0
Golfieri et al[35]	RCT	DEB-TACE	41/26/22	NR		NR		CR 19.2%/26.1%5	0.734
		cTACE	41/23/24					CR 42.1%/22.2%6	0.295

¹In this study, subgroup analysis according to BCLC stage was not performed. However, majority of patients was BCLC-B (DEB-TACE, 81%; cTACE, 71%);

²The 6-mo tumor response rate, according to the European Association for the Study of the Liver response criteria;

³The average 8-mo tumor response rate, according to the EASL response criteria;

⁴The 3-mo tumor response rate, according to the mRECIST;

⁵The 1-mo;

⁶The 6-mo tumor response rate, according to the EASL criteria and mRECIST. RCT: Randomized controlled trial; OS: Overall survival; TTP: Time to progression; NR: Not reported; OR: Objective response; DC: Disease control; CR: Complete response; mRECIST: Modified Response Evaluation Criteria in Solid Tumors; BCLC: Barcelona Clinic Liver Cancer; TACE: Transarterial chemoembolization; DEB: Drug-eluting bead.

Table 2 The incidence of adverse events from studies comparing drug-eluting bead-transarterial chemoembolization and conventional transarterial chemoembolization in patients with unresectable hepatocellular carcinoma

Adverse event	Lammer et al[10]	Wiggermann et al[46]	Song et al[9]	Golfieri et al[35]
Nausea	Post-embolization syndrome 24.7%/25.9%	Post-embolization syndrome 21.7%/16.3%, P = 0.52	Post-embolization syndrome 22.2%/20.6%, P = 0.850	2.2%/3.4%, P = 0.682
Pain				24.7%/71.6%, P = 0.01
Fever				7.9%/11.4%, P = 0.457
Fatigue				0%/4.5%, P = 0.059
Marrow suppression	5.4%/5.6%	NR	NR	NR
Cholecystitis	NR	NR	4.7%/3.3%, P = 0.692	2.2%/1.1%, P = 0.999
Abscess	NR	2	NR	1.1%/1.1%, P = 0.999
Alopecia	1.1%/20.4%	NR	NR	NR
Liver function worsening	Significant reduction in DEB1	NR	AST, 36%/52%, P = 0.259	1.1%/5.7%3, P = 0.118
			ALT, 31%/20%, P = 0.280
Hematoma	NR	NR	NR	1.1%/3.4%, P = 0.368
Infection	NR	NR	NR	0%/1.1%, P = 0.497

¹The mean maximum ALT elevation in the DEB-TACE group was 50% less than in the cTACE group (95%CI: 39%-65%; P < 0.001) and 41% less with regard to AST (95%CI: 46%-76%; P ≤ 0.001);

²Major complications was defined hospitalization > 24 h, greater therapy and unplanned added costs in treatment, permanent persisting sequelae and death of the patient. DEB-TACE vs cTACE, 13.0% (n = 6, including 2 liver abscesses) vs 2.3% (n = 1), P = 0.06;

³Increase in Child-Push score of ≥ 2 points. DEB-TACE: Drug-eluting bead-transarterial chemoembolization; cTACE: Conventional transarterial chemoembolization; ALT: Alanine aminotransferase; AST: Aspartate transaminase; NR: Not reported.