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Jean-luc Raoul - One of the best experts on this subject based on the ideXlab platform.
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Intermediate Stage treatment: Is TACE enough?
Liver International, 2017Co-Authors: Xavier Adhoute, Jean-luc Raoul, Guillaume Penaranda, Marc BourlièreAbstract:We have read with interest the article by Pecorelli et al(1) regarding a new therapeutic approach in Intermediate Stage hepatocellular carcinoma (HCC). In this retrospective analysis, curative treatments (surgery and percutaneous treatments) offer a better outcome compared to the recommended treatment, transarterial chemoembolization (TACE). The strength of this study is the use of propensity score matching and we would like to make few comments to highlight the relevance as well as the limitations of these findings. This article is protected by copyright. All rights reserved.
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Treatment of Intermediate-Stage hepatocellular carcinoma
Nature Reviews Clinical Oncology, 2014Co-Authors: Alejandro Forner, Marine Gilabert, Jordi Bruix, Jean-luc RaoulAbstract:Hepatocellular carcinoma (HCC)—closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease—is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour Stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, Intermediate-Stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with Intermediate-Stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with Intermediate-Stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed. A number of treatments are available for hepatocellular carcinoma (HCC), and their allocation—as well as disease prognosis—is influenced by tumour Stage and the degree of liver-function impairment The current definition of Intermediate-Stage HCC (Barcelona Clinic Liver Cancer [BCLC] Stage B) is extensive multifocal disease confined to the liver, with preserved liver function and no cancer-related symptoms Transarterial chemoembolization (TACE) is considered the standard treatment for Intermediate-Stage HCC in patients with preserved liver function and no cancer-related symptoms Major efforts have been made to improve outcomes among patients treated with TACE; accurate technique together with appropriate patient selection is key to obtaining the best results Sorafenib, the only systemic treatment associated with a survival benefit in HCC, should be considered for patients with BCLC Stage B HCC who are not eligible for TACE Radioembolization has antitumoural efficacy in patients with Intermediate-Stage HCC, but evidence of survival benefit has not been presented and is awaited The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with Intermediate-Stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
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treatment of Intermediate Stage hepatocellular carcinoma
Nature Reviews Clinical Oncology, 2014Co-Authors: Alejandro Forner, Marine Gilabert, Jordi Bruix, Jean-luc RaoulAbstract:The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with Intermediate-Stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
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evolving strategies for the management of Intermediate Stage hepatocellular carcinoma available evidence and expert opinion on the use of transarterial chemoembolization
Cancer Treatment Reviews, 2011Co-Authors: Jean-luc Raoul, Alejandro Forner, L Bolondi, Bruno Sangro, Vincenzo Mazzaferro, Fabio Piscaglia, Riccardo LencioniAbstract:Summary Transarterial chemoembolization (TACE) is considered the gold standard for treating Intermediate-Stage hepatocellular carcinoma (HCC). However, Intermediate-Stage HCC includes a heterogeneous population of patients with varying tumour burdens, liver function (Child-Pugh A or B) and disease aetiology. This suggests that not all patients with Intermediate-Stage HCC will derive similar benefit from TACE, and that some patients may benefit from other treatment options. Results of an extensive literature review into the treatment of unresectable HCC with TACE were combined with our own clinical experience to identify factors that may predict survival after TACE. We also report contraindications to TACE and propose a treatment algorithm for the repetition of TACE. In addition, we have constructed a number of expert opinions that may be used as a guide to help physicians make treatment decisions for their patients with Intermediate-Stage HCC. The data included in the literature review related almost exclusively to conventional TACE, rather than to TACE with drug-eluting beads. Therefore, the findings and conclusions of the literature review are only applicable to the treatment of HCC with conventional TACE. Treating physicians may want to consider other treatment options for patients with Intermediate-Stage HCC who are not suitable for or do not respond to TACE. By distinguishing those patients who represent good candidates for TACE from those where little or no benefit might be expected, it may be possible to make better use of current treatment options and improve outcomes for patients.
Riccardo Lencioni - One of the best experts on this subject based on the ideXlab platform.
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sorafenib or placebo plus tace with doxorubicin eluting beads for Intermediate Stage hcc the space trial
Journal of Hepatology, 2016Co-Authors: Riccardo Lencioni, Josep M Llovet, Jiamei Yang, Alfredo Guglielmi, Seung Woon Paik, Maria Reig, Gar Yang Chau, Angelo Luca, Luis Ruiz Del Arbol, Marieaude LeberreAbstract:Background & Aims Transarterial chemoembolization with doxorubicin-eluting beads (DC Bead®; DEB-TACE) is effective in patients with Barcelona clinic liver cancer Stage B hepatocellular carcinoma (HCC). The multikinase inhibitor sorafenib enhances overall survival (OS) and time-to-tumor progression (TTP) in patients with advanced HCC. This exploratory phase II trial tested the efficacy and safety of DEB-TACE plus sorafenib in patients with Intermediate Stage HCC. Methods Patients with Intermediate Stage multinodular HCC without macrovascular invasion (MVI) or extrahepatic spread (EHS) were randomized 1:1 to DEB-TACE (150mg doxorubicin) plus sorafenib 400mg twice daily or placebo. The primary endpoint was TTP by blinded central review. Secondary endpoints included time to MVI/EHS, OS, overall response rate (ORR) using modified response evaluation criteria in solid tumors, disease control rate (DCR), time to unTACEable progression (TTUP), and safety. Results Of 307 patients randomized, 154 received sorafenib and 153 received placebo. Median TTP for subjects receiving sorafenib plus DEB-TACE or placebo plus DEB-TACE was similar (169 vs . 166days, respectively; hazard ratio (HR) 0.797, p =0.072). Median time to MVI/EHS (HR 0.621, p =0.076) and OS (HR 0.898, p =0.29) had not been reached. The ORRs for patients in the sorafenib and placebo groups with post-baseline scans were 55.9% and 41.3%, respectively, and the DCRs were 89.2% and 76.1%, respectively. TTUP was lower with sorafenib than with placebo (HR 1.586; 95% confidence intervals, 1.200–2.096; median 95 vs . 224days). No unexpected adverse events related to sorafenib were observed. Conclusion Sorafenib plus DEB-TACE was technically feasible, but the combination did not improve TTP in a clinically meaningful manner compared with DEB-TACE alone.
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sorafenib or placebo in combination with transarterial chemoembolization tace with doxorubicin eluting beads debdox for Intermediate Stage hepatocellular carcinoma hcc phase ii randomized double blind space trial
Journal of Clinical Oncology, 2012Co-Authors: Riccardo Lencioni, Marieaude Leberre, Gerold Meinhardt, Josep M Llovet, Jiamei Yang, Kate Nicholson, Jordi BruixAbstract:LBA154^ Background: The global SPACE trial was conducted to evaluate the efficacy and safety of S in combination with TACE with DEBDOX in patients (pts) with Intermediate-Stage HCC (BCLC B). Methods: Pts were eligible if they had asymptomatic, unresectable, multinodular tumors without vascular invasion (VI) or extrahepatic spread (EHS); Child-Pugh A liver functional status; and ECOG PS 0. Pts were randomized to receive S 400 mg bid or matching P continuously (1 cycle = 4 wks) until progression. All pts received TACE with DEBDOX (150 mg doxorubicin; Biocompatibles UK Ltd) 3-7d after first dose of study drug, and then on d1 (±4d) of months 3, 7, and 13, and q6 months thereafter. The primary endpoint was time to radiologic progression (TTP) by independent review (predefined alpha = 0.15). Secondary endpoints were overall survival (OS), time to VI/EHS, time to untreatable progression (TTUP), and safety. Results: Of 452 pts screened, 307 were randomized to S (n=154) or P (n=153). The HR for TTP was 0.797 (95% ...
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evolving strategies for the management of Intermediate Stage hepatocellular carcinoma available evidence and expert opinion on the use of transarterial chemoembolization
Cancer Treatment Reviews, 2011Co-Authors: Jean-luc Raoul, Alejandro Forner, L Bolondi, Bruno Sangro, Vincenzo Mazzaferro, Fabio Piscaglia, Riccardo LencioniAbstract:Summary Transarterial chemoembolization (TACE) is considered the gold standard for treating Intermediate-Stage hepatocellular carcinoma (HCC). However, Intermediate-Stage HCC includes a heterogeneous population of patients with varying tumour burdens, liver function (Child-Pugh A or B) and disease aetiology. This suggests that not all patients with Intermediate-Stage HCC will derive similar benefit from TACE, and that some patients may benefit from other treatment options. Results of an extensive literature review into the treatment of unresectable HCC with TACE were combined with our own clinical experience to identify factors that may predict survival after TACE. We also report contraindications to TACE and propose a treatment algorithm for the repetition of TACE. In addition, we have constructed a number of expert opinions that may be used as a guide to help physicians make treatment decisions for their patients with Intermediate-Stage HCC. The data included in the literature review related almost exclusively to conventional TACE, rather than to TACE with drug-eluting beads. Therefore, the findings and conclusions of the literature review are only applicable to the treatment of HCC with conventional TACE. Treating physicians may want to consider other treatment options for patients with Intermediate-Stage HCC who are not suitable for or do not respond to TACE. By distinguishing those patients who represent good candidates for TACE from those where little or no benefit might be expected, it may be possible to make better use of current treatment options and improve outcomes for patients.
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sorafenib sor or placebo pl in combination with transarterial chemoembolization tace for Intermediate Stage hepatocellular carcinoma space
Journal of Clinical Oncology, 2010Co-Authors: Riccardo Lencioni, Jordi Bruix, Marieaude Leberre, Gerold Meinhardt, D Voliotis, Josep M LlovetAbstract:TPS178^ Background: SOR acts via antiangiogenesis and inhibition of tumor cell proliferation, and has proven efficacy in advanced hepatocellular carcinoma (HCC). It is relevant to assess whether SOR combined with TACE improves clinical outcomes compared with TACE alone. The phase II SPACE study is being conducted in North America, Europe, and the Asia-Pacific region to evaluate the efficacy and safety of TACE (using doxorubicin-eluting beads) plus either SOR or PL in patients (pts) with Intermediate-Stage HCC (BCLC B). Methods: SPACE is a multinational, randomized, double-blind, PL-controlled study. Pts aged ≥18 years diagnosed with Intermediate-Stage HCC (BCLC B; defined as the presence of asymptomatic, unresectable, multinodular tumors without vascular invasion or extrahepatic spread) are eligible if they have Child-Pugh (CP) class A status without ascites; ECOG PS of 0; ≥1 unidimensional lesion measurable according to RECIST; and adequate bone marrow, liver, and renal function. Exclusion criteria inclu...
Jordi Bruix - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Intermediate-Stage hepatocellular carcinoma
Nature Reviews Clinical Oncology, 2014Co-Authors: Alejandro Forner, Marine Gilabert, Jordi Bruix, Jean-luc RaoulAbstract:Hepatocellular carcinoma (HCC)—closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease—is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour Stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, Intermediate-Stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with Intermediate-Stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with Intermediate-Stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed. A number of treatments are available for hepatocellular carcinoma (HCC), and their allocation—as well as disease prognosis—is influenced by tumour Stage and the degree of liver-function impairment The current definition of Intermediate-Stage HCC (Barcelona Clinic Liver Cancer [BCLC] Stage B) is extensive multifocal disease confined to the liver, with preserved liver function and no cancer-related symptoms Transarterial chemoembolization (TACE) is considered the standard treatment for Intermediate-Stage HCC in patients with preserved liver function and no cancer-related symptoms Major efforts have been made to improve outcomes among patients treated with TACE; accurate technique together with appropriate patient selection is key to obtaining the best results Sorafenib, the only systemic treatment associated with a survival benefit in HCC, should be considered for patients with BCLC Stage B HCC who are not eligible for TACE Radioembolization has antitumoural efficacy in patients with Intermediate-Stage HCC, but evidence of survival benefit has not been presented and is awaited The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with Intermediate-Stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
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treatment of Intermediate Stage hepatocellular carcinoma
Nature Reviews Clinical Oncology, 2014Co-Authors: Alejandro Forner, Marine Gilabert, Jordi Bruix, Jean-luc RaoulAbstract:The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with Intermediate-Stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
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sorafenib or placebo in combination with transarterial chemoembolization tace with doxorubicin eluting beads debdox for Intermediate Stage hepatocellular carcinoma hcc phase ii randomized double blind space trial
Journal of Clinical Oncology, 2012Co-Authors: Riccardo Lencioni, Marieaude Leberre, Gerold Meinhardt, Josep M Llovet, Jiamei Yang, Kate Nicholson, Jordi BruixAbstract:LBA154^ Background: The global SPACE trial was conducted to evaluate the efficacy and safety of S in combination with TACE with DEBDOX in patients (pts) with Intermediate-Stage HCC (BCLC B). Methods: Pts were eligible if they had asymptomatic, unresectable, multinodular tumors without vascular invasion (VI) or extrahepatic spread (EHS); Child-Pugh A liver functional status; and ECOG PS 0. Pts were randomized to receive S 400 mg bid or matching P continuously (1 cycle = 4 wks) until progression. All pts received TACE with DEBDOX (150 mg doxorubicin; Biocompatibles UK Ltd) 3-7d after first dose of study drug, and then on d1 (±4d) of months 3, 7, and 13, and q6 months thereafter. The primary endpoint was time to radiologic progression (TTP) by independent review (predefined alpha = 0.15). Secondary endpoints were overall survival (OS), time to VI/EHS, time to untreatable progression (TTUP), and safety. Results: Of 452 pts screened, 307 were randomized to S (n=154) or P (n=153). The HR for TTP was 0.797 (95% ...
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sorafenib sor or placebo pl in combination with transarterial chemoembolization tace for Intermediate Stage hepatocellular carcinoma space
Journal of Clinical Oncology, 2010Co-Authors: Riccardo Lencioni, Jordi Bruix, Marieaude Leberre, Gerold Meinhardt, D Voliotis, Josep M LlovetAbstract:TPS178^ Background: SOR acts via antiangiogenesis and inhibition of tumor cell proliferation, and has proven efficacy in advanced hepatocellular carcinoma (HCC). It is relevant to assess whether SOR combined with TACE improves clinical outcomes compared with TACE alone. The phase II SPACE study is being conducted in North America, Europe, and the Asia-Pacific region to evaluate the efficacy and safety of TACE (using doxorubicin-eluting beads) plus either SOR or PL in patients (pts) with Intermediate-Stage HCC (BCLC B). Methods: SPACE is a multinational, randomized, double-blind, PL-controlled study. Pts aged ≥18 years diagnosed with Intermediate-Stage HCC (BCLC B; defined as the presence of asymptomatic, unresectable, multinodular tumors without vascular invasion or extrahepatic spread) are eligible if they have Child-Pugh (CP) class A status without ascites; ECOG PS of 0; ≥1 unidimensional lesion measurable according to RECIST; and adequate bone marrow, liver, and renal function. Exclusion criteria inclu...
Josep M Llovet - One of the best experts on this subject based on the ideXlab platform.
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ramucirumab for patients with Intermediate Stage hepatocellular carcinoma hcc and elevated alpha fetoprotein afp pooled results from two phase iii studies reach and reach 2
Journal of Clinical Oncology, 2020Co-Authors: Masatoshi Kudo, Peter R Galle, Josep M Llovet, Richard S Finn, Manabu Morimoto, Masafumi Ikeda, Bruno Daniele, Kun Liang, Kenta Shinozaki, Chunxiao WangAbstract:549Background: Intermediate-Stage HCC, as defined as Barcelona Clinic Liver Cancer (BCLC) Stage B, is a heterogeneous disease in terms of liver function and tumor load. REACH (NCT01140347) and REAC...
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sorafenib or placebo plus tace with doxorubicin eluting beads for Intermediate Stage hcc the space trial
Journal of Hepatology, 2016Co-Authors: Riccardo Lencioni, Josep M Llovet, Jiamei Yang, Alfredo Guglielmi, Seung Woon Paik, Maria Reig, Gar Yang Chau, Angelo Luca, Luis Ruiz Del Arbol, Marieaude LeberreAbstract:Background & Aims Transarterial chemoembolization with doxorubicin-eluting beads (DC Bead®; DEB-TACE) is effective in patients with Barcelona clinic liver cancer Stage B hepatocellular carcinoma (HCC). The multikinase inhibitor sorafenib enhances overall survival (OS) and time-to-tumor progression (TTP) in patients with advanced HCC. This exploratory phase II trial tested the efficacy and safety of DEB-TACE plus sorafenib in patients with Intermediate Stage HCC. Methods Patients with Intermediate Stage multinodular HCC without macrovascular invasion (MVI) or extrahepatic spread (EHS) were randomized 1:1 to DEB-TACE (150mg doxorubicin) plus sorafenib 400mg twice daily or placebo. The primary endpoint was TTP by blinded central review. Secondary endpoints included time to MVI/EHS, OS, overall response rate (ORR) using modified response evaluation criteria in solid tumors, disease control rate (DCR), time to unTACEable progression (TTUP), and safety. Results Of 307 patients randomized, 154 received sorafenib and 153 received placebo. Median TTP for subjects receiving sorafenib plus DEB-TACE or placebo plus DEB-TACE was similar (169 vs . 166days, respectively; hazard ratio (HR) 0.797, p =0.072). Median time to MVI/EHS (HR 0.621, p =0.076) and OS (HR 0.898, p =0.29) had not been reached. The ORRs for patients in the sorafenib and placebo groups with post-baseline scans were 55.9% and 41.3%, respectively, and the DCRs were 89.2% and 76.1%, respectively. TTUP was lower with sorafenib than with placebo (HR 1.586; 95% confidence intervals, 1.200–2.096; median 95 vs . 224days). No unexpected adverse events related to sorafenib were observed. Conclusion Sorafenib plus DEB-TACE was technically feasible, but the combination did not improve TTP in a clinically meaningful manner compared with DEB-TACE alone.
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sorafenib or placebo in combination with transarterial chemoembolization tace with doxorubicin eluting beads debdox for Intermediate Stage hepatocellular carcinoma hcc phase ii randomized double blind space trial
Journal of Clinical Oncology, 2012Co-Authors: Riccardo Lencioni, Marieaude Leberre, Gerold Meinhardt, Josep M Llovet, Jiamei Yang, Kate Nicholson, Jordi BruixAbstract:LBA154^ Background: The global SPACE trial was conducted to evaluate the efficacy and safety of S in combination with TACE with DEBDOX in patients (pts) with Intermediate-Stage HCC (BCLC B). Methods: Pts were eligible if they had asymptomatic, unresectable, multinodular tumors without vascular invasion (VI) or extrahepatic spread (EHS); Child-Pugh A liver functional status; and ECOG PS 0. Pts were randomized to receive S 400 mg bid or matching P continuously (1 cycle = 4 wks) until progression. All pts received TACE with DEBDOX (150 mg doxorubicin; Biocompatibles UK Ltd) 3-7d after first dose of study drug, and then on d1 (±4d) of months 3, 7, and 13, and q6 months thereafter. The primary endpoint was time to radiologic progression (TTP) by independent review (predefined alpha = 0.15). Secondary endpoints were overall survival (OS), time to VI/EHS, time to untreatable progression (TTUP), and safety. Results: Of 452 pts screened, 307 were randomized to S (n=154) or P (n=153). The HR for TTP was 0.797 (95% ...
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sorafenib sor or placebo pl in combination with transarterial chemoembolization tace for Intermediate Stage hepatocellular carcinoma space
Journal of Clinical Oncology, 2010Co-Authors: Riccardo Lencioni, Jordi Bruix, Marieaude Leberre, Gerold Meinhardt, D Voliotis, Josep M LlovetAbstract:TPS178^ Background: SOR acts via antiangiogenesis and inhibition of tumor cell proliferation, and has proven efficacy in advanced hepatocellular carcinoma (HCC). It is relevant to assess whether SOR combined with TACE improves clinical outcomes compared with TACE alone. The phase II SPACE study is being conducted in North America, Europe, and the Asia-Pacific region to evaluate the efficacy and safety of TACE (using doxorubicin-eluting beads) plus either SOR or PL in patients (pts) with Intermediate-Stage HCC (BCLC B). Methods: SPACE is a multinational, randomized, double-blind, PL-controlled study. Pts aged ≥18 years diagnosed with Intermediate-Stage HCC (BCLC B; defined as the presence of asymptomatic, unresectable, multinodular tumors without vascular invasion or extrahepatic spread) are eligible if they have Child-Pugh (CP) class A status without ascites; ECOG PS of 0; ≥1 unidimensional lesion measurable according to RECIST; and adequate bone marrow, liver, and renal function. Exclusion criteria inclu...
Alejandro Forner - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Intermediate-Stage hepatocellular carcinoma
Nature Reviews Clinical Oncology, 2014Co-Authors: Alejandro Forner, Marine Gilabert, Jordi Bruix, Jean-luc RaoulAbstract:Hepatocellular carcinoma (HCC)—closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease—is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour Stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, Intermediate-Stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with Intermediate-Stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with Intermediate-Stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed. A number of treatments are available for hepatocellular carcinoma (HCC), and their allocation—as well as disease prognosis—is influenced by tumour Stage and the degree of liver-function impairment The current definition of Intermediate-Stage HCC (Barcelona Clinic Liver Cancer [BCLC] Stage B) is extensive multifocal disease confined to the liver, with preserved liver function and no cancer-related symptoms Transarterial chemoembolization (TACE) is considered the standard treatment for Intermediate-Stage HCC in patients with preserved liver function and no cancer-related symptoms Major efforts have been made to improve outcomes among patients treated with TACE; accurate technique together with appropriate patient selection is key to obtaining the best results Sorafenib, the only systemic treatment associated with a survival benefit in HCC, should be considered for patients with BCLC Stage B HCC who are not eligible for TACE Radioembolization has antitumoural efficacy in patients with Intermediate-Stage HCC, but evidence of survival benefit has not been presented and is awaited The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with Intermediate-Stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
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treatment of Intermediate Stage hepatocellular carcinoma
Nature Reviews Clinical Oncology, 2014Co-Authors: Alejandro Forner, Marine Gilabert, Jordi Bruix, Jean-luc RaoulAbstract:The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with Intermediate-Stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
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evolving strategies for the management of Intermediate Stage hepatocellular carcinoma available evidence and expert opinion on the use of transarterial chemoembolization
Cancer Treatment Reviews, 2011Co-Authors: Jean-luc Raoul, Alejandro Forner, L Bolondi, Bruno Sangro, Vincenzo Mazzaferro, Fabio Piscaglia, Riccardo LencioniAbstract:Summary Transarterial chemoembolization (TACE) is considered the gold standard for treating Intermediate-Stage hepatocellular carcinoma (HCC). However, Intermediate-Stage HCC includes a heterogeneous population of patients with varying tumour burdens, liver function (Child-Pugh A or B) and disease aetiology. This suggests that not all patients with Intermediate-Stage HCC will derive similar benefit from TACE, and that some patients may benefit from other treatment options. Results of an extensive literature review into the treatment of unresectable HCC with TACE were combined with our own clinical experience to identify factors that may predict survival after TACE. We also report contraindications to TACE and propose a treatment algorithm for the repetition of TACE. In addition, we have constructed a number of expert opinions that may be used as a guide to help physicians make treatment decisions for their patients with Intermediate-Stage HCC. The data included in the literature review related almost exclusively to conventional TACE, rather than to TACE with drug-eluting beads. Therefore, the findings and conclusions of the literature review are only applicable to the treatment of HCC with conventional TACE. Treating physicians may want to consider other treatment options for patients with Intermediate-Stage HCC who are not suitable for or do not respond to TACE. By distinguishing those patients who represent good candidates for TACE from those where little or no benefit might be expected, it may be possible to make better use of current treatment options and improve outcomes for patients.