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).


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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.

CONCLUSION

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.

Disclosure

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 


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