Re-evaluating transarterial chemoembolization for the treatment of Hepatocellular Carcinoma

Consensus recommendations and review by an International Expert Panel

Ann Lii Cheng, Deepak Amarapurkar, Yee Chao, Pei Jer Chen, Jean François Geschwind, Khean L. Goh, KwangHyub Han, Masatoshi Kudo, Han Chu Lee, Rheun Chuan Lee, Laurentius A. Lesmana, Ho Yeong Lim, Seung Woon Paik, Ronnie T. Poon, Chee Kiat Tan, Tawesak Tanwandee, Gaojun Teng, Joong Won Park

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Patients with unresectable hepatocellular carcinoma (HCC) usually receive transarterial chemoembolization (TACE) or systemic therapies with intermediate and advanced-stage disease. However, intermediate-stage HCC patients often have unsatisfactory clinical outcomes with repeated TACE and there is considerable uncertainty surrounding the criteria for repeating or stopping TACE treatment. In July 2012, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was re-convened in Shanghai in an attempt to provide a consensus on the practice of TACE, particularly in regard to evaluating TACE 'failure'. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies for intermediate HCC. This review summarizes the evidence discussed at the meeting and provides expert recommendations regarding the use of TACE for unresectable intermediate-stage HCC. A key consensus of the Expert Panel was that the current definitions of TACE failure are not useful in differentiating between situations where TACE is no longer effective in controlling disease locally vs. systemically. By redefining these concepts, it may be possible to provide a clearer indication of when TACE should be repeated and more importantly, when TACE should be discontinued.

Original languageEnglish
Pages (from-to)174-183
Number of pages10
JournalLiver International
Volume34
Issue number2
DOIs
Publication statusPublished - 2014 Jan 1

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Hepatocellular Carcinoma
Therapeutics
Expert Testimony
Uncertainty
Safety

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Cheng, Ann Lii ; Amarapurkar, Deepak ; Chao, Yee ; Chen, Pei Jer ; Geschwind, Jean François ; Goh, Khean L. ; Han, KwangHyub ; Kudo, Masatoshi ; Lee, Han Chu ; Lee, Rheun Chuan ; Lesmana, Laurentius A. ; Lim, Ho Yeong ; Paik, Seung Woon ; Poon, Ronnie T. ; Tan, Chee Kiat ; Tanwandee, Tawesak ; Teng, Gaojun ; Park, Joong Won. / Re-evaluating transarterial chemoembolization for the treatment of Hepatocellular Carcinoma : Consensus recommendations and review by an International Expert Panel. In: Liver International. 2014 ; Vol. 34, No. 2. pp. 174-183.
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abstract = "Patients with unresectable hepatocellular carcinoma (HCC) usually receive transarterial chemoembolization (TACE) or systemic therapies with intermediate and advanced-stage disease. However, intermediate-stage HCC patients often have unsatisfactory clinical outcomes with repeated TACE and there is considerable uncertainty surrounding the criteria for repeating or stopping TACE treatment. In July 2012, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was re-convened in Shanghai in an attempt to provide a consensus on the practice of TACE, particularly in regard to evaluating TACE 'failure'. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies for intermediate HCC. This review summarizes the evidence discussed at the meeting and provides expert recommendations regarding the use of TACE for unresectable intermediate-stage HCC. A key consensus of the Expert Panel was that the current definitions of TACE failure are not useful in differentiating between situations where TACE is no longer effective in controlling disease locally vs. systemically. By redefining these concepts, it may be possible to provide a clearer indication of when TACE should be repeated and more importantly, when TACE should be discontinued.",
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Cheng, AL, Amarapurkar, D, Chao, Y, Chen, PJ, Geschwind, JF, Goh, KL, Han, K, Kudo, M, Lee, HC, Lee, RC, Lesmana, LA, Lim, HY, Paik, SW, Poon, RT, Tan, CK, Tanwandee, T, Teng, G & Park, JW 2014, 'Re-evaluating transarterial chemoembolization for the treatment of Hepatocellular Carcinoma: Consensus recommendations and review by an International Expert Panel', Liver International, vol. 34, no. 2, pp. 174-183. https://doi.org/10.1111/liv.12314

Re-evaluating transarterial chemoembolization for the treatment of Hepatocellular Carcinoma : Consensus recommendations and review by an International Expert Panel. / Cheng, Ann Lii; Amarapurkar, Deepak; Chao, Yee; Chen, Pei Jer; Geschwind, Jean François; Goh, Khean L.; Han, KwangHyub; Kudo, Masatoshi; Lee, Han Chu; Lee, Rheun Chuan; Lesmana, Laurentius A.; Lim, Ho Yeong; Paik, Seung Woon; Poon, Ronnie T.; Tan, Chee Kiat; Tanwandee, Tawesak; Teng, Gaojun; Park, Joong Won.

In: Liver International, Vol. 34, No. 2, 01.01.2014, p. 174-183.

Research output: Contribution to journalArticle

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AU - Chao, Yee

AU - Chen, Pei Jer

AU - Geschwind, Jean François

AU - Goh, Khean L.

AU - Han, KwangHyub

AU - Kudo, Masatoshi

AU - Lee, Han Chu

AU - Lee, Rheun Chuan

AU - Lesmana, Laurentius A.

AU - Lim, Ho Yeong

AU - Paik, Seung Woon

AU - Poon, Ronnie T.

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AU - Teng, Gaojun

AU - Park, Joong Won

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N2 - Patients with unresectable hepatocellular carcinoma (HCC) usually receive transarterial chemoembolization (TACE) or systemic therapies with intermediate and advanced-stage disease. However, intermediate-stage HCC patients often have unsatisfactory clinical outcomes with repeated TACE and there is considerable uncertainty surrounding the criteria for repeating or stopping TACE treatment. In July 2012, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was re-convened in Shanghai in an attempt to provide a consensus on the practice of TACE, particularly in regard to evaluating TACE 'failure'. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies for intermediate HCC. This review summarizes the evidence discussed at the meeting and provides expert recommendations regarding the use of TACE for unresectable intermediate-stage HCC. A key consensus of the Expert Panel was that the current definitions of TACE failure are not useful in differentiating between situations where TACE is no longer effective in controlling disease locally vs. systemically. By redefining these concepts, it may be possible to provide a clearer indication of when TACE should be repeated and more importantly, when TACE should be discontinued.

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