122OShould transarterial chemoembolization be continued after non-response to the first two sessions for intermediate-stage hepatocellular carcinoma?

Abstract Background Current guidelines recommend that two transarterial chemoembolization (TACE) should be performed before switching to another treatment for intermediate-stage HCC, but without robust evidence. Considering the paucity of effective subsequent treatments after TACE-refractoriness, we aimed to evaluate radiologic response of HCC to the third TACE (TACE-3) after nonresponse (stable disease (SD) or progressive disease (PD)) to the first two sessions, and to establish a nomogram to predict responders to TACE-3. Methods The study enrolled 1672 intermediate-stage HCC patients with Child-pugh A liver function (training cohort: n = 918; internal validation cohort: n = 460; external validation cohort: n = 294) who did not respond to (based on mRECIST) the first two TACE but underwent ≥3 consecutive TACE from three centers. Radiologic response rate to TACE-3 and its correlation with overall survival (OS) was evaluated. Nomogram predicting responders to TACE-3 was established and validated. Results For patients with SD after the first two TACE, the response rate after TACE-3 was 44.4% in training and internal validation cohorts and 51.5% in external validation cohort. For patients with PD, corresponding rates were 2.7% and 2.2%. Responders to TACE-3 achieved higher 5-year OS rates than non-responders in three cohorts (all P  Conclusions Approximately 50% of patients with SD could respond to TACE-3 with improved survival whereas patients with PD barely could. Our nomogram is effective in predicting responders to TACE-3. Legal entity responsible for the study The First Affiliated Hospital of Sun Yat-sen University. Funding The National Natural Science Foundation of China (No. 81801703), the Guangdong Natural Science Foundation of Guangdong Province (No. 2018A030310282), the National high level talents special support plan--"Ten thousand plan"--Young top-notch talent support program, the National Science Fund for Distinguished Young Scholars (No. 81825013). Disclosure All authors have declared no conflicts of interest.