Plans among American medical oncologists (AMO) for inclusion of trans-arterial chemo-embolization (TACE) as part of first-line therapy in patients with liver only hepatocellular carcinoma (HCC) not amenable to surgical therapy.

Abstract

e14617 Background: TACE is a widely applied management strategy for patients with HCC. Methods: Using an extensively tested live, case-based, market research vehicle to anonymously acquire prescribing plan data, we assessed plans of > 300 AMOs to include TACE as part of first-line therapy for the setting of extensive intrahepatic HCC, no extrahepatic spread, Childs Pugh status A and PS 1. The consulting interventional radiologist feels the patient is a candidate for TACE. Results: 13% reported no experience with use of TACE. Among the remaining 87%, 30% would plan immediate TACE followed by “systemic therapy consolidation”; 24% TACE followed by observation until progression; 15% TACE and concurrent systemic therapy; 8% systemic therapy followed by TACE; 8% systemic therapy alone; 2% other. In a follow up question concerning the primary driver of these prescribing plans, the largest subgroup (26%) indicated that their plan for TACE followed by systemic therapy was based on the (incorrect) belief that “TACE will only stabilize intrahepatic disease so additional systemic therapy is needed for tumor regression”. Conclusions: TACE is effective therapy in HCC with the potential to improve survival. The majority of AMOs would plan some type of TACE therapy strategy in this setting but our data suggest awareness of evidence based approaches is low. There are no available data to show that adding concurrent or sequential systemic therapy improves the outcome of TACE alone. Phase III testing of this concept is ongoing. There appears to be a major need to clarify among AMOs the optimum use of TACE and systemic therapy in the setting of inoperable HCC without macroscopic extra-hepatic spread. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Xcenda