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EXPERT POINT OF VIEW: Jordi Bruix, MD, PhD, and Flavio G. Rocha, MD


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THE STUDY’S invited discussant, Jordi Bruix, MD, PhD, of the University of Barcelona, Spain, said one of the benefits of the TACTICS study was to evaluate the use of the new unTACEable-based endpoint, which he favors.

Jordi Bruix, MD, PhD

Jordi Bruix, MD, PhD

“The endpoint used in the trial is a good attempt to do something new that may be affirmative for activity of combinations in the field of chemoembolization. However, it needs to be refined,” he said. He added, however, this novel endpoint requires validation to determine its appropriateness as an endpoint for survival.

“Co-adjuvant sorafenib to TACE is safe and may provide benefits that need to be further confirmed,” Dr. Bruix said. “If the mature survival data are encouraging, we should conduct a confirmatory study in the West with a large sample size.”

In January 2018, Dr. Bruix’s group published the 2018 (revised) Barcelona (BCLC) prognostic and treatment strategy algorithm,1 which guides clinicians through the multiple options for hepatocellular carcinoma by stage. For intermediate-stage patients, chemoembolization is the first choice as an attempt to improve survival. Criteria to start transarterial chemoembolization (TACE) include disease confined to the liver, no vascular invasion or extrahepatic spread, absence of cancer-related symptoms, and Child-Pugh A compensated disease. Expected median survival after TACE applying such criteria exceeds 30 months, he noted.

Flavio G. Rocha, MD

Flavio G. Rocha, MD

Flavio G. Rocha, MD, of Virginia Mason Hospital and Medical Center, added that the recent update of the liver cancer staging system, by Dr. Bruix’s team at the Barcelona Liver Clinic, is helpful for selecting treatment. “The challenge now is that as new drugs and technologies emerge, how to sequence them,” he told The ASCO Post. He added that the new proposed UnTACEable endpoint is provocative. “It’s exciting to hear about it at this meeting, and it suggests maybe we should look at TACE differently now, with this new endpoint.” ■

DISCLOSURE: Dr. Bruix is a consultant or advisor for Argyle, Bayer Schering Pharma, Bristol-Myers Squibb, BTG Pharmaceuticals, Eisai, Kowa, Novartis, Onxeo, Roche, and Sirtex Medical; is a member of speakers bureaus for Bayer Schering Pharma, BTG Pharmaceuticals, and Sirtex Medical; and has received research funding from Bayer Schering Pharma. Dr. Rocha reported no conflicts of interest.

REFERENCE

1. Forner A, Reig M, Bruix J: Hepatocellular carcinoma. Lancet. January 4, 2018 (early release online).


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