Safety evaluation of combination treatment of drug-eluting bead transarterial chemoembolization and immune checkpoint inhibitors for hepatocellular carcinoma: An increased risk of liver abscess with treatment interval less than one month

Sung-Hua Chiu; Hsuan-Hwai Lin; An-Chieh Feng; Cheng-Hsiang Lo; Chung-Bao Hsieh; Pin-Ko Chen; Wei-Chou Chang

doi:10.1016/j.ejrad.2023.111266

Safety evaluation of combination treatment of drug-eluting bead transarterial chemoembolization and immune checkpoint inhibitors for hepatocellular carcinoma: An increased risk of liver abscess with treatment interval less than one month

Eur J Radiol. 2024 Jan:170:111266. doi: 10.1016/j.ejrad.2023.111266. Epub 2023 Dec 15.

Authors

Sung-Hua Chiu¹, Hsuan-Hwai Lin², An-Chieh Feng³, Cheng-Hsiang Lo⁴, Chung-Bao Hsieh³, Pin-Ko Chen⁵, Wei-Chou Chang⁶

Affiliations

¹ Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan.
² Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
³ Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Radiotherapy, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁵ Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁶ Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: weichou.chang@gmail.com.

PMID: 38185027
DOI: 10.1016/j.ejrad.2023.111266

Abstract

Purpose: To analyze the safety of combination treatment comprising drug-eluting bead transarterial chemoembolization (DEB-TACE) and immune checkpoint inhibitors (ICIs) in hepatocellular carcinoma (HCC).

Method: In total, 208 HCC patients receiving DEB-TACE were enrolled for this retrospective single-institution study. Among them, 50 patients who received ICIs at an interval less than one month from DEB-TACE were categorized into the DEB-ICI group; the remaining 158 patients were categorized into the DEB group. Albumin-bilirubin (ALBI) score before and at three months after DEB-TACE were recorded to evaluate liver function changes. Adverse events within three months after DEB-TACE were considered TACE-related and were compared between the two groups.

Results: The DEB-ICI group had significantly higher incidence of liver abscess than the DEB group (14.0 % versus 5.1 %, p-value = 0.0337). No significant difference in the other TACE-related adverse events and change of ALBI score between the groups. Univariate logistic regression confirmed that combination with ICIs was an independent risk factor for liver abscess after DEB-TACE (odds ratio = 3.0523, 95 % confidence interval: 1.0474-8.8947, p-value = 0.0409); other parameters including subjective angiographic chemoembolization endpoint scale and combined targeted therapy were nonsignificant risk factors in this study population. In the DEB-ICI group, patients who received ICIs before DEB-TACE exhibited a trend toward liver abscess formation compared with those who received DEB-TACE before ICIs (23.8 % versus 6.9 %, p-value = 0.0922).

Conclusions: Combination treatment involving DEB-TACE and ICIs at an interval less than one month increased the risk of liver abscess after DEB-TACE. Greater caution is therefore warranted for HCC patients who receive ICIs and DEB-TACE with this short interval.

Keywords: Carcinoma; Chemoembolization; Hepatocellular; Immune checkpoint inhibitors; Immunotherapy; Liver Neoplasms; Therapeutic.

MeSH terms

Carcinoma, Hepatocellular* / pathology
Chemoembolization, Therapeutic* / adverse effects
Doxorubicin
Humans
Immune Checkpoint Inhibitors
Liver Abscess* / etiology
Liver Neoplasms* / pathology
Retrospective Studies
Treatment Outcome

Substances

Immune Checkpoint Inhibitors
Doxorubicin