Combination of transarterial chemoembolisation (TACE) plus antivirals for the management of hepatitis B-related hepatocellular carcinoma: A systematic review of the literature

Background: Hepatocellular carcinoma (HCC) is the most frequently occurring liver neoplasm and the fifth most common cancer worldwide. Intermediate-stage HCC is a distinct disease entity that is traditionally treated with transarterial chemoembolisation (TACE). However, the risk of viral reactivation and subsequent hepatic decompensation is considerable. Therefore, in this systematic review, we explore the evidence surrounding the benefits of using TACE/antiviral combination in this subset of HCC. Methods: PubMed, Medline, the Cochrane Library, Trip Database, and Google Scholar were searched using the terms "Hepatocellular carcinoma'' OR "Hepatoma'' or "Liver cancer'' AND "Transarterial chemoem-bolisation'' OR "Chemoembolisation'' AND "Antivirals'' and specifying only English literature. The outcomes of interest included progression-free survival and overall survival (PFS and OS), tumour response, and toxicities. Results: A total of six potentially relevant trials were identified, from which one study was excluded. Hence, five trials involving 818 patients were included, encompassing three phase II studies and two retrospective studies. The median PFS was reported in one out of the five studies, which was 23 months in the combination arm versus 20 months in the TACE-only arm. The median OS was reported in one out of the four studies: 29 months in the combination arm versus 26 months in the TACE-only arm. The hepatic toxicity parameters showed consistent benefit for the combination arm versus the TACE-only arm in the five studies included. Conclusions: An antiviral/TACE combination shows promise as an effective and tolerable treatment strategy for intermediate-stage HCC. The reported efficacy and toxicity of the antiviral/TACE combination appears to compare favorably with TACE monotherapy, the most commonly implemented strategy for intermediate-stage HCC. Further clinical studies are warranted to accurately determine which patients are expected to benefit most from such combination strategies. (C) 2015 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.