Progress in hepatoprotective strategies during TACE treatment

Transarterial chemoembolization (TACE) is a cornerstone locoregional therapy for intermediate to advanced hepatocellular carcinoma and liver metastases, achieving tumor control through selective arterial embolization and localized delivery of chemotherapeutic agents. However, its efficacy is often limited by collateral injury to nontumorous liver tissue caused by ischemia–reperfusion injury (IRI), chemotherapeutic toxicity, inflammatory activation, microcirculatory dysfunction, and metabolic disturbances, which restrict repeated treatment and compromise long-term outcomes. Increasing evidence suggests that TACE-associated liver injury is a dynamically regulated process amenable to targeted intervention. Recent advances in embolic material design, microenvironment-responsive drug delivery systems, and modulation of oxidative stress, inflammation, and immune responses have enabled more precise local therapy with reduced off-target hepatic damage. Emerging hepatoprotective materials and delivery platforms, such as pH-sensitive microspheres and ROS-responsive siRNA-delivering nanogels, have shown potential in reducing off-target hepatic damage. Strategies such as superselective embolization, tumor microenvironment (TME) modulation, and controlled drug release demonstrate the potential to enhance antitumor efficacy while preserving liver functional reserve. This review summarizes key mechanisms of TACE-induced liver injury, emerging hepatoprotective materials and delivery platforms, and future directions for integrating materials science with biological regulation in interventional oncology.