P-32 Accessibility to Sequential Systemic Treatment After Tace: Impact on Survival in a Latin American Prospective Cohort
Year: 2024
Type: article
Study design: Observational Study
Abstract: Conflict of interest No Introduction and Objectives Stopping rules following transarterial chemoembolization (TACE), either tumor progression or “unTACEable” progression are needed. Avoiding liver decompensation after TACE may lead better access to systemic treatment and survival. These scenarios are unknown in our region. We aimed to evaluate accessibility to systemic therapy following TACE and its impact on survival. Patients / Materials and Methods A multicenter prospective cohort study conducted in Latin America, included HCC patients receiving TACE from May 15, 2018 to March 15, 2024. We excluded patients on the liver transplant waiting list, or Child Pugh C. Survival since first TACE was compared between groups accessing (A) and not accessing (no-A) to systemic therapy after TACE through Cox proportional hazard survival analysis, and adjusted treatment effect was further evaluated using a propensity score (PS) and inverse probability treatment weighting (IPTW). Results and Discussion rom 258 receiving TACE, 188 were included after excluding 33 patients on the waiting list and 37 Child C (Table). Access to any systemic therapy was 46.8% (95% CI 39.5-54.2%), within a median time from TACE to first line of 9 months (range 3.7-17.0). In group A (n=88) systemic treatments following TACE were sorafenib 62.5%, atezolizumab + bevacizumab 31.8%, and lenvatinib 4.5%. Paradoxically, while presenting better liver function reserve, liver decompensation after TACE was more frequent in group A (7% vs 0%; P=0.004), without significant differences regarding median number of TACEs, modality, or tumor burden. Median survival since first TACE between groups was A 37.4 months vs no-A 29.8 months [HR 0.69 (95% CI 0.44-1.10), adjusted for the HAP score (Figure), which was unchanged after PS and IPTW. Conclusions In our region, less than half of HCC systemic treatment candidates acceded to sequential TACE-systemic therapy. Although not statistically significant, due to underpowered estimations, numerically higher survival was achieved with TACE-systemic therapies.
Source: Annals of Hepatology
Authors: FEDERICO PIÑERO, Margarita Anders, Carla Bermúdez, Diego Arufe, Adriana Varón, Ana Palazzo, Jorge Rodríguez, Oscar Beltrán, Patricio Palavecino Rubilar, Leonardo Gomes da Fonseca, Ezequiel Ridruejo, Norberto Tamagnone, Hugo Cheinquer, Nicolás Cortés Medina, Juan Ignacio Marín, Estela Manero, Federico Orozco Ganem, Jaime Poniachik, Sebastián Marciano, Virginia Reggiardo, Manuel Mendizabal
Institutions: Hospital Universitario Austral, Hospital Alemán, Hospital Italiano de Buenos Aires, Institute of Cardiology, Hospital Clínico de la Universidad de Chile, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Fundación Santa Fe de Bogotá, Hospital Pablo Tobon Uribe
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W4405119121