The purpose of this study was to assess the safety and efficacy of
doxorubicin-loaded beads (DC Beads) delivered by transarterial embolization for the treatment of unresectable
hepatocellular carcinoma (HCC). This open-label, single-center, single-arm study included 62 cirrhotic patients with documented single unresectable HCC. Mean
tumor diameter was 5.6 cm (range, 3-9 cm) classified as Okuda stages 1 (n = 53) and 2 (n = 9). Patients received repeat embolizations with
doxorubicin-loaded beads every 3 months (maximum of three). The maximum
doxorubicin dose was 150 mg per embolization, loaded in DC Beads of 100-300 or 300-500 microm. Regarding efficacy, overall, an objective response according to the European Association for the Study of the Liver criteria was observed in 59.6%, 81.8%, and 70.8% across three treatments. A complete response was observed in 4.8% after the first procedure and 3.6% and 8.3% after the second and third procedures, respectively. At 9 months a complete response was seen in 12.2%, an objective response in 80.7%, progressive disease in 6.8%, and 12.2% showed stable disease. Mean
tumor necrosis ranged from 77.4% to 83.9% (range, 28.6%-100%) across three treatments.
alpha-Fetoprotein levels showed a mean decrease of 1123 ng/ml (95% CI = 846-1399; p = 3 x 10(-11)) after the first session and remained stable after the second and third embolizations (42 and 70 ng/ml decrease, respectively). Regarding safety,
bilirubin, gamma-glutamyl
transferase,
aspartate aminotransferase,
alanine aminotransferase, and
alkaline phosphatase showed only transient increases during the study period. Severe procedure-related complications were seen in 3.2% (
cholecystitis, n = 1;
liver abscess, n = 1). Postembolization syndrome was observed in all patients. We conclude that hemoembolization using
doxorubicin-loaded DC Beads is a safe and effective treatment of HCC as demonstrated by the low complication rate, increased
tumor response, and sustained reduction of
alpha-fetoprotein levels.