Drug-eluting Beads in the Treatment of Hepatocellular Carcinoma and Colorectal Cancer Metastases to the Liver

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy (70–85 %)¹ with an associated mortality of >600,000 per year.^2,3 Underlying cirrhosis is the major risk factor,² with an estimated annual risk of developing HCC of 4–8 %.^2,4 Hepatitis B is responsible for 53–80 % of all cases.2 Hepatitis C is the major cause of HCC in Japan, the US, Latin America and Europe.³ Untreated HCC patients have a median survival of 3–8 months.⁵

Nearly one million patients are diagnosed with colorectal cancer (CRC) worldwide every year.⁶ Thirty to fifty percent of them develop hepatic metastases (hmCRC);^6–8 hmCRC is responsible for two-thirds of CRC deaths.⁸ One- and five-year survival rates for untreated hmCRC patients are <30 % and <5 %, respectively.²²

Treatment Options
The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly used for HCC.⁹ It takes into account underlying liver disease, tumour characteristics and general performance status.^4,10 About 30 %4 ofpatients in Western countries identified as having BCLC stage 0 or A HCC are eligible for curative treatments, including liver transplantation (LT), liver resection (LR) and various ablation techniques (ATs).¹¹

LT provides excellent outcomes applying the Milan criteria, withfive-year survival rate of 70 % and recurrence rates below 15 %.¹² LT is the only curative option for the underlying cirrhosis.^13,14 However, because of the shortage of potential liver donors and progression of the HCC, the risk of dropout from liver transplantation waiting lists is up to 4 % per month.¹⁵ LR is the treatment of choice for HCC in non-cirrhotic patients (~5 % of cases in Western countries, ~40 % in Asia).¹⁵ In the case of underlying cirrhosis, candidates need to be carefully selected to diminish the risk of post-operative liver failure with increased risk of death.^15,16 In HCC patients after LR, the risk of tumour recurrence exceeds 70 % at five years.¹⁵

ATs include chemical (e.g., percutaneous ethanol injection [PEI]) and thermal (e.g., radiofrequency ablation [RFA]) ablation. PEI results in five-year survival rates of 47–53 % (Child–Pugh class A, early-stage tumours).¹⁷ PEI has high local recurrence rates of 33–43 %.¹⁷ For RFA, depending on Child–Pugh class and location of lesions in the liver in early-stage HCC patients, five-year survival rates of around 60 % have been reported.¹⁷

In hmCRC, unlike HCC, LR is the only potential curative standard treatment.^18–20 In patients with hmCRC, LR provides five-year survival ratesin the range of 25–58 %.¹⁸ However, only 10–20 % of patients are suitable for LR.^2,21 Recurrence rates for hmCRC after LR range from 60–70 %.²²

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