TACE plus thermal ablation improves survival in liver cancer

Combining transarterial chemoembolization (TACE) with subsequent thermal ablation improves survival in patients with unresectable hepatocellular carcinoma, according to findings published July 30 in JAMA Oncology. 

In a phase III trial involving 241 participants, a group from Sun Yat-sen University Cancer Center in Guangzhou, China, evaluated whether sequential TACE and thermal ablation could improve clinical outcomes over TACE alone, with findings supporting the combination as a first-line treatment option for these patients. 

“Despite its antitumor effects through localized chemotherapy delivery and embolization of tumor-feeding arteries, TACE alone yields modest survival outcomes, with a median progression-free survival (PFS) of approximately 7 to 8 months,” wrote corresponding authors Ming Zhao, MD, and Min-Shan Chen, MD, and colleagues. 

TACE delivers chemotherapy directly to liver tumors while cutting off their blood supply and is the standard of care for intermediate-stage hepatocellular carcinoma (HCC) that is not amenable to curative treatments such as resection or transplant, the authors explained. Despite its antitumor effects, TACE alone yields modest survival outcomes, and residual viable tumor after treatment remains a major driver of disease progression, they noted. 

To evaluate whether adding thermal ablation to eliminate that residual disease could improve outcomes, the researchers recruited 241 patients with stage B HCC for a clinical trial conducted at two Chinese medical centers between May 2015 and August 2024. Patients were assigned 1:1 to receive either conventional TACE followed by CT-guided radiofrequency ablation or TACE alone. 

According to the results, median progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 was 17.7 months with TACE-ablation versus 7.3 months with TACE alone (hazard ratio [HR], 0.47; p < .001). TACE-ablation also resulted in statistically significant prolonged untreatable PFS compared with TACE (35.1 months vs 12.3 months; HR, 0.40; p < 0.001). 

Median overall survival (OS) was 88.6 months with TACE-ablation versus 35.1 months with TACE alone (HR, 0.50; p < 0.001). PFS and OS benefits were consistent across subgroups, with clinically meaningful improvements observed particularly in patients with low to moderate tumor burden scores. 

In secondary results, TACE-ablation also significantly prolonged untreatable PFS, defined as time to progression no longer suitable for further study treatment or death, at 35.1 months versus 12.3 months with TACE alone (HR, 0.40; p < 0.001). Confirmed objective responses per modified RECIST were observed in 84% of the TACE-ablation group versus 57% of the TACE-alone group, the researchers reported. 

“These findings support TACE followed by subsequent ablation as a first-line treatment option for liver-confined unresectable HCC,” the group wrote. 

In an accompanying editorial, Cynthia Yeung, MD, of the University of Texas MD Anderson Cancer Center in Houston, and Howard Lim, MD, PhD, of the University of British Columbia in Vancouver, wrote that the study provides robust randomized evidence that the combined approach delivers substantial and durable survival benefit. TACE combined with ablation has been practiced across Asia for more than a decade, they added. 

“Meanwhile, Western centers have shifted toward transarterial radioembolization with yttrium-90 (Y-90) or, more recently, TACE combined with immune checkpoint inhibitors (ICIs),” Yeung and Lim wrote. 

Resolving the optimal sequencing question – and identifying which patient subgroups are best served by each approach – will require more data: a prospective head-to-head trial of TACE and selective ablation vs TACE plus ICI, ideally stratified by tumor burden and intent (downstaging vs durable local control), the pair suggested. 

Read the full study here.