Progression after molecular targeted agents: Hepatic arterial changes and transarterial chemoembolization in hepatocellular carcinoma

Background/Aim: The purpose of this study was to determine changes in the hepatic arteries after treatment with a molecular targeted agent (MTA), and evaluate the safety and efficacy of transarterial chemoembolization (TACE) as a post-MTA treatment in patients with hepatocellular carcinoma (HCC). Patients and Methods: The cases of 33 patients with intermediate HCC treated with MTA and TACE were studied retrospectively. The hepatic arteries, and the safety and efficacy of TACE were evaluated before and after MTA treatment. Results: Following long-term MTA treatment, the diameters of hepatic arteries decreased significantly, while there was no difference in the diameters of the splenic artery or the portal vein. No significant adverse events were observed due to TACE after MTA; however, the therapeutic effect of TACE was limited after MTA treatment. Conclusion: This study demonstrated that the diameters of hepatic arteries were significantly smaller than those before MTA induction, suggesting ischemic effects and tumor vessel “normalization” by MTA treatment. Although TACE can be performed as a post-MTA treatment without lowering the hepatic reserve or causing serious complications, its therapeutic effect is limited.