Arterial Infusion Chemotherapy Superior to TACE in Large Hepatocellular Cancer

Regional therapies are the predominant initial treatment approach for confined, unresectable hepatocellular cancer, but their application may be limited by local tumor size and extent. Investigators from China now report results of a trial in which patients with large hepatocellular cancers were randomized to treatment with hepatic arterial infusion (HAI) of 5-FU, leucovorin, and oxaliplatin every 3 weeks for up to 6 cycles or to transarterial chemoembolization (TACE) with lobaplatin, epirubicin, and lipiodol every 6 weeks. Eligibility criteria included size of the largest liver lesion ≥7 cm.

Of 315 patients, 88% were male, 89% had hepatitis B–related disease, 47% had tumor size >10 cm, and 46% had 1 or 2 lesions. The primary endpoint of overall survival was superior with HAI compared to TACE (median, 23.1 vs. 16.1 months; hazard ratio, 0.58; P<0.001). The HAI group also had longer median progression-free survival (9.6 vs. 5.4 months; HR, 0.57; P<0.001) and higher rate of tumor response (46% vs. 18%, P<0.001). The rate of serious adverse events was higher for TACE compared to HAI (30% vs. 19%; P=0.03).