Transarterial chemoembolization (TACE) followed by thermal ablation was associated with improved survival outcomes compared with TACE alone in patients with liver-confined, unresectable hepatocellular carcinoma, according to findings from the phase III TORCH trial published by Lyu et al in JAMA Oncology.
“TACE is the standard of care for liver-confined hepatocellular carcinoma that is not amenable to curative treatment; however, TACE has demonstrated unsatisfactory survival benefits,” the investigators commented. “Sequential TACE/ablation could serve as a feasible treatment option….”
Study Details
A total of 241 patients with Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma from two tertiary medical centers in China were randomly assigned in a 1:1 ratio to receive either TACE alone or TACE combined with subsequent selective radiofrequency ablation.
The investigators identified progression-free survival per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 as the primary endpoint. Overall survival, treatment response and progression-free survival per modified RECIST, untreatable progression-free survival, and safety were evaluated as secondary endpoints.
Key Findings
At the data cutoff, median progression-free survival per RECIST version 1.1 was 17.7 months (95% confidence interval [CI] = 11.4–23.1 months) with TACE/ablation and 7.3 months (95% CI = 6.4–10.4 months) with TACE alone (hazard ratio [HR] = 0.47, 95% CI = 0.34–0.65; P < .001). TACE/ablation was also found to significantly prolong untreatable progression-free survival (35.1 vs 12.3 months; HR = 0.40, 95% CI = 0.27–0.58; P < .001). Median overall survival was 88.6 (95% CI = 43.1 months to not estimable) vs 35.1 months (95% CI = 25.4–45.5 months), respectively (HR = 0.50, 95% CI = 0.34–0.73; P < .001).
The 6-and-12 tumor burden scores were less than 6, 6 to 12, and greater than 12 points in 34 (28.1%), 79 (65.3%), and 8 (6.6%) patients treated with TACE/ablation, and 31 (25.8%), 76 (63.3%), and 13 (10.8%) in those who received TACE alone, respectively. Patients with low to moderate tumor burden scores (≤ 6 and 6–12 points) were found to experience clinically meaningful improvements in both progression-free and overall survival.
Treatment-related grade 3 or 4 adverse events were observed in 23 (23.2%) and 24 (18.3%) patients treated with TACE/ablation and TACE alone, respectively.
The investigators concluded, “In the phase III TORCH randomized clinical trial, TACE followed by selective thermal ablation provided superior progression-free survival and overall survival with manageable safety compared with TACE alone in patients with liver-confined, unresectable hepatocellular carcinoma.”
“Patients with low to moderate tumor burden scores who meet [ablation-after-TACE–specific up-to-7] criteria after TACE may represent the optimal candidate population for combined therapy,” they added. “These findings support TACE followed by subsequent ablation as a first-line treatment option for liver-confined, unresectable hepatocellular carcinoma.”
Ming Zhao, MD, and Min-Shan Chen, MD, of Sun Yat-sen University Cancer Center, Guangzhou, China, are the corresponding authors of the article in JAMA Oncology.
Disclosure: The study was supported by the Sun Yat-sen University Cancer Center Clinical Research 308 Program, the National Natural Science Foundation of China, and the Chen Xiao-ping Foundation for the Development of Science and Technology. The study authors reported no conflicts of interest.
