TACE in pediatric HCC patients
Palliative TACE is a standard procedure in adults with solitary or multifocal HCC without extrahepatic metastases. However, in children, only few cases were reported. Back in 2,000, Malogolowkin et al55 reported that all eleven children (18 months–14 years old) with unresectable, chemotherapy-resistant liver tumors (three with HCC) responded – five (one with HCC) went on to surgical resection and three survived. The conclusion was that TACE with a suspension of cisplatin, doxorubicin, and mitomycin mixed with lipiodol is feasible, well-tolerated, and effective in achieving surgical resectability in pediatric patients. These encouraging results were confirmed by Czauderna et al56 (five patients, 1–12 years old, one with HCC).
Thus, TACE could be offered to patients with chemotherapy-resistant liver tumor for palliative care or even with the goal of achieving surgical resectability and cure.
Research has to be done to characterize the molecular and genomic mechanisms of pediatric HCC to support the development of novel therapeutic approaches and the implementation of personalized medicine. At the moment, it would be worth initiating clinical studies to evaluate bevacizumab combined with standard chemotherapy (PLADO or GEMOX with sorafenib), c-met inhibitors like cabozantinib in tumors with high MET expression, and immune checkpoint blockade agents like nivolumab.
The authors report no conflicts of interest in this work.
Irene Schmid,1 Dietrich von Schweinitz,2
1Department of Pediatric Hematology and Oncology, 2Department of Pediatric Surgery, Dr. von Hauner Children`s Hospital, Ludwig-Maximilians-University, Munich, Germany
1. Czauderna P, Mackinlay G, Perilongo G, et al. Hepatocellular carcinoma in children: results of the first prospective study of the International Society of Pediatric Oncology group. J Clin Oncol. 2002;20:2798–2804.
2. Litten JB, Tomlinson GE. Liver tumors in children. Oncologist. 2008;13:812–820.
3. Czauderna P, Lopez-Terrada D, Hiyama E, Häberle B, Malogolowkin MH, Meyers RL. Hepatoblastoma state of the art: pathology, genetics, risk stratification, and chemotherapy. Curr Opin Pediatr. 2014;26:19–28.
4. McGlynn KA, London WT. The global epidemiology of hepatocellular carcinoma, present and future. Cin Liver Dis. 2011;15:223–243.
5. Chen WJ, Lee JC Hung WT. Primary malignant tumour of the liver in infants and children in Taiwan. J Pediatr Surg. 1988;23:457–461.
6. Chan KL, Fan ST, Tam PK, Chiang AK, Chan GC, Ha SY. Paediatric hepatoblastoma and hepatocellular carcinoma: retrospective study. Hong Kong Med J. 2002;8:13–17.
7. Chen JC, Chen CC, Chen WJ, Lai HS, Hung WT, Lee PH. Hepatocellular carcinoma in children: clinical review and comparison with adult cases. J Pediatr Surg. 1998;33:1350–1354.
8. Czauderna P. Adult type vs. Childhood hepatocellular carcinoma–are they the same or different lesions? Biology, natural history, prognosis, and treatment. Med Pediatr Oncol. 2002;39:519–523.
9. Buendia MA. Genetic alterations in hepatoblastoma and hepatocellular carcinoma: common and distinctive aspects. Med Pediatr Oncol. 2002;39:530–535.
10. Czauderna P, Maibach R, Aronson D, et al. Hepatocellular carcinoma in children: results of the second prospective study of the International Society of Pediatric Oncology (SIOP): SIOPEL 2. Med Pediatr Oncol. 2003;41:269.
11. Schmid I, Albert MH, Häberle B, et al. HB99–Hepatozelluläre Karzinome: Behandlungsergebnisse und neue Konzepte [HB99 hepatocellular carcinomas: treatment results and new concepts]. Monatsschr Kinderheilkd. 2008;156:412. German.
12. Katzenstein HM, Krailo MD, Malogolowkin MH, et al. Hepatocellular carcinoma in children and adolescents: results from the Pediatric Oncology Group and the Children’s Cancer Group intergroup study. J Clin Oncol. 2002;20:2789–2797.
13. Murawski M, Weeda VW, Maibach R, et al. Hepatocellular carcinoma in children: does modified platinum- and doxorubicin-based chemotherapy increase tumor resectability and change outcome? Lessons learned from the SIOPEL 2 and 3 studies. J Clin Oncol. 2016;34:1050–1056.
14. Downward J. Targeting RAS signalling pathways in cancer therapy. Nat Rev Cancer. 2003;3:11–22.
15. Wilhelm SM, Carter C, Tang L, et al. BAY 43-9006 exhibits broad spectrum oral antitumor activity and targets the RAF/MEK/ERK pathway and receptor tyrosine kinases involved in tumor progression and angiogenesis. Cancer Res. 2004;64:7099–7109.