Drug-eluting TACE plus systemic chemotherapy versus systemic chemotherapy alone in advanced lung adenocarcinoma: a PSM study

To compare drug-eluting transarterial chemoembolization (DE-TACE) followed by systemic chemotherapy versus systemic chemotherapy alone for advanced lung adenocarcinoma that has progressed after targeted therapy. All patients undergoing DE-TACE followed by systemic chemotherapy (DE-TACE group) or systemic chemotherapy alone (chemotherapy group) for stage III-IV lung adenocarcinoma from January 2018 to January 2022 were screened. On day 1 of each 21-day cycle, patients received pemetrexed (500 mg/m2) and cisplatin (75 mg/m2). Patients in the DE-TACE group received cisplatin (75 mg/m2) and gemcitabine (600 mg/m2) via the feeding arteries and then embolization using drug-eluting beads carrying gemcitabine (400 mg). DE-TACE was repeated if deemed necessary based on CT examination three weeks later. Overall survival (OS) and treatment-emergent adverse events (TEAEs) were compared in the overall cohort, as well as propensity score-matched (PSM) cohort (1:1 ratio with 0.05 caliper width). The final analysis included 62 and 69 patients in the chemotherapy and DE-TACE groups, respectively. Within the 49-month median follow-up, the median OS was 18.3 months and 33.6 months in the chemotherapy and DE-TACE groups, respectively, with a hazard ratio (HR) of 0.18 (95% CI 0.1–0.32; P < 0.001). In the PSM analysis (36 patients per group), the median OS was 18.3 and 33.1 months in the chemotherapy and DE-TACE groups, respectively (HR 0.11, 95% CI 0.05–0.26; P < 0.001). The rate of grade 3 or higher TEAEs in the PSM analysis was 44.4% (16/36) in the chemotherapy group versus 5.6% (2/36) in the DE-TACE group (P < 0.001). Compared to chemotherapy alone, DE-TACE followed by chemotherapy was associated was associated with significantly prolonged overall survival and substantially reduced high-grade treatment-related toxicity in patients with lung adenocarcinoma that progressed after targeted therapy.