Case Report: Hepatocellular Carcinoma (HCC) Successfully Managed with TACE

Dear Friends,

Below is a case report I recently received from Stefan, a visitor of this website. The case report is related to his sister-in-law, a 74-years lady, who has successfully managed a Hepatocellular Carcinoma (HCC) with a transarterial chemoembolization (TACE) performed at a hospital in Romania, Cluj.

My purpose in sharing this with you is to create positive reference points for you. To see and believe that tumors can be destroyed regardless of their type and stage. There are different solutions for that and TACE is one such solution.

Although I did not had the chance to allocate a specific article to TACE, we have often discussed TACE as a good tool to locally address tumors. Nearly 3 years ago, I mentioned TACE as one of the most effective solutions in my view, to address tumors locally https://www.cancertreatmentsresearch.com/some-of-the-most-effective-treatments-in-my-view/. This can be a great tool to address tumors (primary or metastasis) located at the liver and lungs. I heard of doctors open to even perform such intervention for brain tumors. It can be given with embolization or regionally by releasing chemo into a region of the body without embolization (when more tumors need to be addressed at the same time). The major advantage is that higher dose can be given at a specific location, while the dose is small enough from a systemic point of view so that there are much much less side effects compared to the typical IV (systemic) administration of chemo. The disadvantage is that tumors can only be addressed locally and not in the whole body at the same time. And the price may be high (about 5000USD) if this is not covered by insurance. But still accessible for many. And again, its a great tool to address locally tumors, specifically the large ones. For those who would like to know more about TACE, here is a short summary of that, but you can also address questions via the comments field located at the bottom of this page.

Back, to the case report I would like to share with you here, Stefan has kindly asked his sister in law to consolidate her treatment history and related results, and shared that with be so that in turn I can share it with you.

Its a pleasure for me to be able to share this successful results, and I promise there are more great case reports that will be coming soon.

Case Report:

Hello Daniel,

I got the latest information from the sister, but I understand it.

Woman, 74 years old.

2008 – Diagnostic-Hepatic Cirrhosis.

03.2014 – alpha feto protein (AFP)-4.53

03.2015 – AFP-118.

10.2015 – Diagnostic-hepatocarcinoma 21 / 9mm

11.2015 – AFP-400 Performed radiofrequency ablation

02.2016  – AFP 4.59

03.2016 – diagnostic-hepatocarcinoma in segment 6-7

12.2016 – AFP-300

02.2017 – AFP-1366

02.2017 – chemotherapy with nexavar begins

04.2017 – a 35 mm nodular structure appears on the ultrasound

05.2017 – stops chemo for 7 days for platelet recovery as it decreased to less than 62. Restarts chemo for a week after which it is definitively discontinued. During the chemo period, cachexia manifested itself very aggressively and in all its forms, with drastic effects on the body. Weight recovery was very slow and long

06.2017 – radiofrequency ablation without positive effects

06.2017 – CT-to lung, 11mm star-node. From 06.017 to 12.2017, AFP evolved from 2015 to 14357

01.2018 – PET-CT confirms 55/28 mm hipodense liver tumors, bilobate and non-homogeneous FDG (suv max. 7.5). Subsequently, in the neighboring segment 7 inferolateral, a 15 mm cyst without FDG capture is distinguished. FDG capture form (max. 6) of 40/20 mm diameter, located endoluminal to the check level. The lungs, bilaterally expanding, present in LSD segment 2, a 6 mm node, not sufficiently characterizing PET. PET Conclusions: liver tumor, metabolic activity is maintained; active metabolic cecal node; biopsy and endoscopic assessment

02.2018 – Endoscopy

02.2018 – AFP 23000

04.2018 – programming for TACE (Oncology Hospital in Cluj, Romania) on 12.06

12.06.2018 – AFP over 30000

12.06.2018 -TACE with 75 mg doxorubicin, including 5-10 ml gelaspon

05.07.2018 – AFP dropped to 2000

20.07.2018 – CT indicates – embolized node was reduced from 60 to 40 mm. The 2015 ablation scar was diminished. Dimensionally reduced also the nodule near the diaphragm

08.09.2018 – AFP 4.8 at 2 months from TACE

20.09.2018 – MRI with Primovist contrast substance. Cirrhosis-shaped liver with irregular capsular contours. Segment 7 reveals two necrotic beaches following treatment of HCC nodules at these 35 / 25mm and 28/21mm levels respectively. In segment 3 close to the round ligament crack is shown a small 9 mm hipercaptant node, possibly the dysplastic node (10-11 mm) without dilated bile ducts. Intra and extrahepatic. No thrombosis at the port axis. Spline increased in volume with an axle of about 18 mm. Pancreas, adrenal glands of normal MRI appearance. Without ascites fluid

I wrote here exactly what I received from my sister-in-law.

Good bless you all,
Stefan

Disclaimer:

This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site and linkages to other sites, I provide general information for educational purposes only. The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. I am not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site. This is just my own personal opinion regarding what we have learned on this road.

Please read an extended version of the Disclaimer here: https://www.cancertreatmentsresearch.com/?page_id=1794

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17 thoughts on “Case Report: Hepatocellular Carcinoma (HCC) Successfully Managed with TACE

    1. It depends on what is expected from the specific chemo/substance used. If necrosis is expected, TLS will also come with that such as in the case of the boy treated with 3BP at the hospital in Frankfurt, Germany. If the cancer cell is dying via apoptosis which is the case for many chemotherapies, there should be no TLS issue. In the above case, the patient did not stated anything about TLS related complications.

      Besides the above, I have received recently several great reports from advanced and diificult to treat cancer patinets with amazing results in short time (a few months) when combining IPT or normal chemo with metabolic treatments. As soon as I can I will report on that but I think we are on to something big there. A pattern is emerging.

      1. Yeah I remember that case. Sad. With new therapies (and really, possibly with every cancer, because each is different) cell death can be too high for apoptosis to happen. TACE is one of multiple new exciting tumor-targeting strategies that almost act as non-invasive spot-treatment for cancer. Ultrasonic O2 bubbles in sequence with other O2 therapies is a similar non-invasive localized treatment I’m super interested.

        I think one of the great things about localized treatments like this is that if TLS does occur, you can limit the potential of kidney failure or urea acidosis by means of treating only one tumor at a time.

        I’m looking forward to hearing about your new data. IPT is a great way to leverage the warburg effect to get chemo in the cell.

  1. Stiu acum-gratie acestui site- ca orice chemo prezinta 3 riscuri majore:TLS,ascitasi casexie.Cred ca prin TACE se reduc substantial aceste riscuri.Exista un argument cel putin in ceea ce priveste casexia.Aceasta s-a manifestat virulent in perioada de chemo(02-05.2017) iar acum,dupa TACE, au fost forme usoare care au fost depasite dupa 5 zile.

    Google translation of the above:

    “I know now – thanks to this site – that any chemo shows 3 major risks: TLS, ascites casex. I think TACE significantly reduces these risks. There is an argument at least regarding casexia. This has been virulent during the chemo period ( 02-05.2017) and now, after TACE, there were mild forms that were exceeded after 5 days.”

  2. D, I have just been reading some of the original 3-BP research that looked at embolization versus 3-BP treatment in the liver.
    This article from July 2002(!) is still quite an eye-opener! 3-BP treatment appeared to have NO side-effects and yet it dramatically reduced cancer cell number and it largely prevented metastasis. This article and others like it must have started an entirely new conversation about the future of cancer treatment in the 21st Century.
    http://cancerres.aacrjournals.org/content/62/14/3909.long

    The article appears to be making strong claims that typical TACE as used in humans leads to severe side effects, while 3-BP treatments avoids all of these problems. Their statement might be intended more as a specific reference to the particular lab model setup that they are using in the article, though any clarification you might provide would be appreciated.

    Article is open access so here is an extended quote:
    “In Contrast to Direct Intraarterial Injection of 3-BrPA, Conventional Therapy for Advanced-Stage Liver Tumors Using Embolization Results in Significant Damage to Surrounding Liver Tissue.

    We next inquired how this new strategy compares with the approach, called “embolization” or “chemoembolization,” that is currently used to treat advanced stage liver cancer in humans (5 , 6 , 8 , 19 , 20) . Embolization involves blocking the hepatic artery feeding the tumor with a resin-like material mixed with an oil base (e.g., polyvinyl alcohol in Ethiodol), thus depriving the tumor of its oxygen and nutrient sources. Chemoembolization refers to the same procedure but with the inclusion of one or more anticancer agents. Using the same rabbit model, we found that embolization alone of the hepatic artery (Fig. 3A) ⇓ leading into the VX2 tumor causes such severe damage to the surrounding liver tissue that it is visually evident (Fig. 3B) ⇓ . This is in sharp contrast to the normal-appearing liver tissue surrounding VX2 tumors that were not embolized but instead were subjected to direct intraarterial injection of 3-BrPA (Fig. 3C) ⇓”

    1. Hi J, regarding 3BP, for me things are like this:
      – when used as IV, with no special formulation, it can be very helpful in my experience
      – however, when used in trans arterial embolisation, the only positive and well described case I know it’s the Dutch boy … the others or actually somewhat negative …
      Specifically, regarding embolization with 3BP I have 3 major sources including some info I cannot disclose here:
      – experience of Dr. Williams (who is an expert in TACE and did 3BP as well) with whom we were in direct contact for long time
      – info from direct contact with patients (or caregivers) who had embolized 3BP
      – the report on the Dutch boy and my direct contact with his dad (a scientist) sharing all the details and being extremely positive on 3BP by TACE as he saw the results with own eyes
      First and second info channels reporting negative outcome (tumor reduction followed by faster growth) while the third reporting positive outcome.

      But now I think I know why the IV seems to be more positive, while the embolisation ends up as more on the negative side … just now, while writing and connecting all the info in my mind, the answer arrived 🙂

  3. D, I have some comments about metronomic dosing that are more on an intuitive than rigorously empirical or theoretical level.

    One of these observations relates to Don’s description of his prostate cancer. What I found of such interest with his particular report was how the ongoing- day in day out- application of his plant based Gerson diet has had an ongoing influence in moving down his markers. It is very impressive. Almost right from the start of this diet the markers started to fall and they have continued to fall! I made a note of this on the compass because it is so striking to me. The integrative treatments that did not work, did not work right from the first month; the treatments that did work did so quickly. Whenever people rearrange their life to be orthogonal to how they have always lived, there should be multiple factors working for them. Cancer should be telling people that the way they are living is what caused the problem. Therefore, live in the opposite way to heal.

    Don’s use of treatments such as 3-BP even when successful only showed occasional blips against the background of the overall trend. From this I can appreciate the importance of having some sort of base treatment that is pushing
    the markers steadily in one direction. You could top it up from there, though you really need a treatment that is exerting a force 24/7.

    For when you have a treatment such as a diet it can exert an ongoing effect against the tumor. One might term any treatment that is constantly acting against the tumor to be metronomic. So, a diet such as Gerson, or calorically restricted KD etc. can all be thought of as metronomic. This lead me to realize that alternative medicine has had this as a central part of their entire treatment philosophy, while conventional medicine has used this somewhat ridiculous idea of maximal dosing and then resting. The benefits of attacking cancer constantly, though not with maximal short term dosing should be obvious.

    Another surprise for me is that when you look into pubmed with the search metronomic and cancer, what you find is that much of the literature seems based on the premise that metronomic dosing’s primary target is anti-angiogenic. This was a large surprise to me. Why would they have made this assumption? For me metronomic metabolic treatment would seem the most obvious. Yet, I do not know whether this idea has any great research history. It is difficult to understand, though your 2-DG clinical trial is possibly the only metabolic therapy using metronomic dosing to advance to the clinic.

    This is all quite self-apparent, though when this occurred to me it still seemed profound. Powerful treatments results can result from a constant application of therapeutic force through time. In terms of mechanisms, these might include metabolic (ATP depletion), chronobiology, cell cycle, cell repair, etc.

    1. Thanks J. After enough research of a specific are of life (in this case oncology), the more intuitive and more simple views are the most powerful. This is why I very much appreciate them when they come from someone also with the knowledge of the details. So, thanks for sharing your feelings.

      Indeed the conventional medicine tends to go mostly for the lower frequency and higher dose approach. I think the reason for that is related to both the available human- and financial-resources, and these places into a specific regulatory context. In other words, it’s difficult and expensive to implement metronomic treatments as in many cases the patient needs to stay in the hospital while having a needle inserted into his arm. Another reason why the medical world ends up with the low frequency high dose option is related to the very high cost of the clinical trials. When you hit with the hammer (higher doses), there is (at least mentally) a higher chance to see a result in the clinical trial during a relatively short term. This is even how a clinical trial starts – by focusing on the highest tolerable dose. And the approach used in the clinical trial will be the one used to design new treatment protocols for the hospitals.

      J. I will start soon a post on why I think metronomic treatments are essential. Not as stand alone necessarily but even better combined with the typical high dose approach of other treatments. I am sure you will like the subject because I will disclose an idea that is both simple and powerful connecting several of the observations we have discussed during the past years.

      1. D, this is fantastic that you also see great potential for metronomic treatment!
        Sometimes there can be an idea that is present though people do not fully appreciate its true value.

        Metronomics gives yet one more treatment amplification!
        This is one of the most powerful concepts that I have encountered in cancer treatment.
        {I am somewhat confused though about https://www.ncbi.nlm.nih.gov/pubmed/?term=30170097
        did they actually treat with MG metronomically in vivo?}

        Looking forward to reading your article.
        Best Wishes, Jcancom

  4. The TheraBionic P1 medical device is now the only treatment option approved in the EU for patients with advanced hepatocellular carcinoma in whom TACE and other approved systemic treatments such as sorafenib, lenvatinib, regorafenib, and immunotherapy stop working or are no longer tolerated.

    Information about the TheraBionic P1 device can be found on the therabionic.com web site

    Prof. Dr. med. Boris Pasche
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    Email: [email protected]
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