[Comparative effect of CalliSpheres drug loading microspheres and lipiodol transarterial chemoembolization in the treatment of huge primary liver cancer]

Drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma in elderly patients: Efficacy and impact on survival benefit and PD-L1 and PD-1 levels

BACKGROUND

Traditional hepatic artery embolization chemotherapy for treatment of liver cancer is often associated with an unsatisfactory prognosis since the tumor cells remain. Drug-loaded lipid microspheres can assist in further killing residual cancer cells and play an important role in the regulation of PD-1 and PD-L1 in the immune response.

AIM

To evaluate the efficacy of drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma in elderly patients, and to analyze its effect on the survival benefit and programmed death-1 ligand (PD-L1) and programmed death 1 (PD-1) levels.

METHODS

From October 2015 to October 2018, 112 elderly patients with hepatocellular carcinoma treated at our hospital were selected. According to the principle of controlled design, the patients were randomly divided into either an observation group (n = 56) or a control group (n = 56). The control group received traditional transcatheter arterial chemoembolization, and the observation group received HepaSphere drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization. The efficacy and serum tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), thymidine kinase 1 (TK-1)], tumor angiogenesis-related indicators [vascular endothelial cell growth factor (VEGF), basic fibroblast growth factor (bFGF), and microvessel density (MVD)], and tissue PD-L1 and PD-1 levels were compared between the two groups. The adverse reactions during the treatment period and the survival status of the two groups at 6 mo, 1 year, and 2 years after treatment were also recorded.

RESULTS

The total effective rate in the observation group was 83.93%, which was higher than that (67.86%) of the control group (P < 0.05). Compared with the values before treatment, serum AFP, CEA, CA199, and TK-1 levels in the two groups were significantly reduced after treatment; these tumor markers in the observation group were significantly lower than those of the control group after treatment (P < 0.05). Compared with the values before treatment, the levels of serum VEGF, bFGF, and MVD in the two groups were significantly reduced after treatment; these tumor angiogenesis-related indicators in the observation group were significantly lower than those of the control group (P < 0.05). Compared with the values before treatment, the levels of PD-L1 and PD-1 in the two groups were significantly reduced after treatment; they were also significantly lower in the observation group than in the control group (P < 0.05). During treatment, there was no significant difference in the incidence of nausea, vomiting, abdominal pain, fever, or fatigue between the two groups (P > 0.05). The 1- and 2-year survival rates of the observation group were significantly higher than those of the control group (P < 0.05).

CONCLUSION

Drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization have a significant effect in the treatment of hepatocellular carcinoma in elderly patients, and this combination therapy can effectively inhibit the expression of PD-L1 and PD-1 in cancer tissues and help improve the survival of patients.

Treatment Response, Survival, and Safety of Transarterial Chemoembolization With CalliSpheres® Microspheres Versus Conventional Transarterial Chemoembolization in Hepatocellular Carcinoma: A Meta-Analysis

BACKGROUND

Drug-eluting embolic transarterial chemoembolization (DEE-TACE) is an advance in TACE technique. However, at present there is insufficient evidence to support that DEE-TACE is superior to conventional TACE (cTACE) for hepatocellular carcinoma (HCC). The aim of this meta-analysis is to evaluate the efficacy and safety of TACE with CalliSpheres® microspheres (CSM-TACE) compared with cTACE in patients with HCC.

DATA SOURCES

PubMed, Embase, Web of Science, CNKI and Wanfang Databases were searched to identify relevant articles published before March 26, 2020. The data regarding treatment response, survival profile, adverse events and liver function indexes were retrieved.

RESULTS

A total of 16 studies with 1454 HCC patients (722 treated with CSM-TACE and 732 with cTACE) were included. Patients receiving CSM-TACE had higher 1-month complete response (CR), objective response rate (ORR), disease control rate (DCR) (odds ratio (OR): 2.00, 95% confidence interval (95% CI): 1.29-3.09; OR: 2.87, 95% CI: 2.15-3.83; OR: 2.01, 95% CI: 1.37-2.95, respectively), 3-month CR, ORR, DCR (OR: 4.04, 95%CI: 2.46-6.64; OR: 3.39, 95%CI: 2.45-4.70; OR: 1.71, 95%CI: 1.14-2.55 respectively), and 6-month CR, ORR, DCR (OR: 4.02, 95%CI: 2.26-7.16; OR: 3.00, 95%CI: 2.05-4.38; OR: 2.66, 95%CI: 1.70-4.16 respectively) than those treated with cTACE. Furthermore, CSM-TACE exhibited a trend toward improved progression free survival (hazard ratio (HR): 0.86, 95%CI: 0.67-1.11) and overall survival (HR: 0.79, 95%CI: 0.59-1.07) over cTACE although these differences did not reach statistical significance. In terms of safety, the two TACE treatments showed similar post-treatment pain (OR: 0.84, 95%CI: 0.55-1.28), fever (OR: 0.99, 95%CI: 0.60-1.63), nausea/vomiting (OR: 0.84, 95% CI: 0.60-1.17), as well as 1-month follow-up alanine aminotransferase (Mean difference (MD): -3.66, 95%CI: -10.38-3.07), aspartate aminotransferase (MD: -2.30, 95%CI: -8.91-4.31) and total bilirubin (MD: -0.15, 95%CI: -2.26-1.96).

CONCLUSION

CSM-TACE displays superior treatment response, non-inferior survival profile and safety over cTACE in HCC patients.