Clinical

New score predicts who will benefit from TACE retreatments

Last Updated: 2013-09-20 11:55:08 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - A new score accurately predicts which patients will benefit from repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), researchers from Austria report.

"We think that this is probably currently the best and most objective way of assessing which patients should undergo further TACE treatment," Dr. Markus Peck-Radosavljevic from AKH & Medical University of Vienna in Austria told Reuters Health.

The score, called Assessment for Retreatment with TACE (ART), was developed by Dr. Peck-Radosavljevic and colleagues and incorporates radiologic tumor response and impairment of liver function after the first TACE.

It can be calculated as the sum of three variables: 4 points for an AST increase by 25%; 1.5 or 3 points for a Child Pugh increase of 1 or at least 2 points, respectively; and 1 point for the absence of radiologic tumor response.

In this study, the researchers investigated the prognostic significance of the ART score prior to the third and fourth TACE and the feasibility of an ART score-guided retreatment strategy.

One hundred four patients received a third or fourth TACE. The median overall survival of the entire group was 17.1 months, the researchers report online September 4 in the Journal of Hepatology.

Patients with an ART score of 0-1.5 points before their third TACE had significantly longer median overall survival than did patients with an ART score of 2.5 or higher (28.1 vs. 8.5 months, p<0.001). Results were similar for patients anticipating their fourth TACE.

An ART score of 2.5 or higher was also associated with a higher frequency of serious adverse events after the third TACE.

For patients assessed as having a good prognosis before their second TACE, reassessment before their third TACE still contributed to their prognosis. Results were similar for patients assessed sequentially before their third and fourth TACE.

"This suggests that the sequential assessment of the ART score is reliable and that the first detection of a dismal ART score (at least 2.5 points) should prompt research into the optimal treatment options for these patients," the researchers explain.

"Patients with an ART score of 1.5 and lower should undergo further TACE treatment as long as it is indicated by the tumor (viable tumor that can be treated with TACE)," Dr. Peck-Radosavljevic said.

"Patients with an ART score of 2.5 and above have a dismal outcome with further TACEs and should not undergo TACE again. However, it is unclear at this point whether their outcome could be improved with further treatment (could only be drug treatment with sorafenib according to the stage-migration concept) or whether these patients cannot be helped with sorafenib treatment, in which case they would either receive best supportive care or they would be incorporated into clinical trials."

"Prospective trials of an ART score-guided treatment strategy with regards to what to do with patients with high ART score would be of great importance," Dr. Peck-Radosavljevic said. "We are also encouraging further validation of the ART score in different patient populations (etiology of liver disease, tumor burden, ethnic groups, etc.) in order to confirm the universal applicability of the score."

Liver surgeon Dr. Olivier Soubrane, who was not involved in the new research, said it "gives robust data to provide a standard approach" to making decisions about retreatment with TACE.

"The decision concerns patients with ART score >2.5 and a dismal prognosis and a predicted over-morbidity of TACE," Dr. Soubrane, from Hopital St. Antoine in Paris, told Reuters Health by email. "In this sub-group, retreatment should be avoided."

SOURCE: http://bit.ly/16u8OPs

J Hepatol 2013.