Transarterial chemoembolization failure/refractoriness: A scientific concept or pseudo-proposition.

Area of Science:

• Hepatobiliary Medicine
• Interventional Oncology
• Clinical Trial Design

Background:

• Intermediate-stage hepatocellular carcinoma (HCC) often requires multi-session transarterial chemoembolization (TACE).
• HCC heterogeneity can limit TACE effectiveness, leading to the concept of TACE failure or refractoriness.
• Tyrosine kinase inhibitors are being explored to manage TACE failure/refractoriness.

Purpose of the Study:

• To critically evaluate the existing definitions and clinical rationale for TACE failure/refractoriness in HCC treatment.
• To assess the evidence supporting the continuation of TACE after a diagnosis of failure or refractoriness.
• To propose a revised definition for TACE failure/refractoriness based on current evidence.

Main Methods:

• Systematic review of published literature on TACE failure/refractoriness in HCC.
• Analysis of clinical trial data and expert consensus documents.
• Evaluation of evidence regarding treatment continuation post-TACE failure.

Main Results:

• The concept of TACE failure/refractoriness is controversial, with ambiguous definitions and limited supporting data.
• Few studies have rigorously examined the rationality behind current definitions.
• Evidence on the feasibility of continuing TACE after declared failure is scarce.

Conclusions:

• Current definitions of TACE failure/refractoriness lack robust evidence and clarity.
• Re-evaluation and potential redefinition of TACE failure/refractoriness are necessary.
• Clinical practice and trial design should consider these ambiguities to optimize HCC management.