Trans-arterial embolization for hepatocellular carcinoma: with or without epidoxorubicin?

Trans-arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with HCC not candidate for surgery and with a preserved hepatic function. In sharp contrast with the large volume of single-institution experiences with TACE published in the last decades, relatively few randomized controlled trials (RCT) have been reported (1). Considering that TACE represents the most frequent therapy adopted in HCC patients (2,3), high level of evidences are welcome in this setting. In the RCT published by Karen T. Brown in the issue of April of Journal of Clinical Oncology, authors tried to verify what is the effect of doxorubicin addition on response and outcome after embolization with microspheres (4). Between December 2007 and April 2012, 51 patients were randomly assigned to receive embolization with Bead-Block (BB) and 50 patients to receive embolization with microspheres loaded with 150 mg of doxorubicin (DEB-TACE). Both arms started the treatment with the same size of microspheres (100–300 μm). Authors did not find any difference in terms of the primary endpoint (radiological tumor response according to the RECIST 1.0 criteria) nor in terms of m-RECIST, safety, progression-free survival or overall survival. Authors concluded that there was no apparent difference between the two treatments questioning the necessity of using doxorubicin.