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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
ARTICLE HIGHLIGHTS
Research background
Transarterial chemoembolization (TACE) is the treatment of choice in intermediate hepatocellular carcinoma (HCC). Doxorubicin is largely used but without solid evidence in literature.
Research motivation
Growing research suggests that idarubicin is a serious candidate for use in TACE with one phase 1 clinical trial using lipiodol emulsion and a phase 1 as well as two phase 2 trials using drug-eluting beads. Idarubicin was never compared to doxorubicin in this setting. Because of multiple worldwide doxorubicin shortages, realization of TACE in patients with Barcelona Clinic Liver Cancer B becomes challenging and finding new alternatives to doxorubicin seems essential.
Research objectives
The objective of this study was to compare idarubicin-based TACE (Ida-TACE) with doxorubicin-based TACE (Dox-TACE) in the treatment of intermediate HCC in terms of anti-tumor efficacy and safety.
Research methods
All patients undergoing TACE between January 2012 and December 2014 were screened and included with the following inclusion criteria: Child-Pugh score A or B, a performance status below or equal to 1, and no prior TACE. Lipiodol emulsion 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. Objective tumor response of TACE was assessed based on mRECIST criteria by independent radiologists. Progression-free survival and liver-transplant free survival were compared between groups using log-rank tests.
Research results
Both treatment group showed comparable characteristics. There were no differences in objective tumor response, progression-free survival, and liver-transplant free survival between Dox- and Ida-TACE. No additional toxicity was observed with idarubicin-TACE.
Research conclusions
Idarubicin showed comparable efficacy and safety to doxorubicin in TACE and may represent a new option in the management of patients with Barcelona Clinic of Liver Cancer B HCC. In this study, due to the vast majority of patients treated by TACE using lipiodol, this constitutes the largest cohort of patients treated with idarubicin during TACE with delivery through lipiodol-emulsion.
Research perspectives
Idarubicin represents a serious alternative to doxorubicin without complicating the procedure or increasing its toxicity. As lipiodol TACE is the most widespread technique to deliver chemotherapy, these results should easily help to improve HCC patient care worldwide. These results need to be confirmed by further clinical studies, and a phase II trial is scheduled.
