Liver cancer treatment can be determined with even greater precision
(Vienna 26th February 2013) Around a third of patients suffering from liver cancer respond very poorly to the standard treatment for inoperable cancer, which involves transarterial chemoembolization (TACE). A team at the University Department of Internal Medicine III led by hepatologist Markus Peck-Radosavljevic has now developed a new test that will be able to predict the patient's future response to the treatment after just the first unit of therapy. This means that the type of therapy can be determined with even greater precision than before – with life-prolonging consequences for the patients affected.
The ART score (Assessment for Retreatment with TACE), which was developed at the MedUni Vienna (shared initial author: Wolfgang Sieghart and Florian Hucke) and evaluated using data from the MedUni Innsbruck, allows the effectiveness of TACE to be predicted after the first round of treatment, says Peck-Radosavljevic: “This enables us to determine who should continue being treated with transarterial chemoembolization and who should be switched to drug-based forms of therapy.”
The average life expectancy of patients with inoperable liver cancer who have a good response to TACE therapy is around 24 months, and six months if their response is poor. “If the group of patients with a poor response is switched to drugs, we anticipate an increase in the average life expectancy to at least eleven months."
TACE is a minimally invasive radiological procedure used to treat inoperable liver cancer. The arteries that supply the liver with blood are blocked up with tiny amounts of a chemotherapy agent (embolization). This causes the tumours to die. TACE can, however, also have a negative effect on the liver’s function as a result of the blockages in the arterial supply to the liver. “It is therefore important to use the ART score in order to rethink therapy options for patients in whom this form of treatment would only have negative effects,” says the MedUni researcher, who from April 2013 will be the Secretary-General of the European Liver Association (EASL) – the first Austrian ever to be appointed to the role.
The ART score itself is based on three parameters: After the first round of treatment, measurements are taken to determine whether the tumour has shrunk, and whether the GOT level has increased by more than a quarter (GOT is an enzyme that is secreted when the liver is being damaged). At the same time, any change in the Child-Pugh Score is assessed - a scoring system used to classify liver cirrhosis into stages. Depending on the overall result of this score, it is possible to predict whether TACE therapy will have the desired effects or not. Investigations into the ART score have now been published in the highly respected journal Hepatology.
„The ART of decision making: retreatment with TACE patients with heptocellular carcinoma.“ W. Sieghart, F. Hucke, M. Pinter, I. Graziadei, W. Vogel, C. Müller, H. Heinzl, M. Trauner, M. Peck-Radosavljevic. Hepatology. 2013 Jan 12. doi: 10.1002/hep.26256.