Efficacy and safety of drug-eluting bead transarterial chemoembolization combined with hepatic arterial infusion chemotherapy in unresectable gastric cancer with liver metastasis.

Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of cancer-related mortality worldwide. The liver is the primary metastatic site, and the prognosis of gastric cancer with liver metastasis (GCLM) remains poor. While transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) are used for liver cancer, their roles in GCLM remain underexplored. This study aimed to evaluate the efficacy and safety of drug-eluting bead TACE (DEB-TACE) combined with HAIC in patients with unresectable GCLM. This was a retrospective, single-center cohort study. We retrospectively analyzed 62 patients with GCLM treated at Peking University Cancer Hospital between July 2018 and June 2023. Patients underwent 135 sessions using either HepaSphere beads plus HAIC-FOLFOX (HEPA-HAIC, n = 33) or DC bead plus HAIC-FOLFOX (DCB-HAIC, n = 29). The primary endpoint was median overall survival (mOS); secondary endpoints included median hepatic progression-free survival (mhPFS), median progression-free survival (mPFS), tumor response, and safety. Among the patients (53 male, 9 female), 75.8% had intestinal-type cancer. Over 95% underwent prior treatments. The mOS was 10.7 months in both groups. The HEPA-HAIC cohort achieved longer mhPFS (8.6 vs 7.6 months) and mPFS (5.7 vs 4.4 months), though not statistically significant. Objective response rate and disease control rate were similar (30.3%/75.8% vs 31.0%/75.9%). Propensity score matching confirmed these findings. Univariate Cox regression suggested primary tumor location and carcinoembryonic antigen were prognostic for hPFS and OS, respectively. No treatment-related deaths occurred. Common adverse events (AEs) were transaminase elevation and pain. Nausea, vomiting, and severe pain were significantly less frequent with HEPA-HAIC (5.6% vs 31.7%, p = 0.001; 4.2% vs 31.7%, p < 0.001; 8.3% vs 22.2%, p = 0.01). DEB-TACE plus HAIC was feasible and demonstrated intrahepatic disease control with acceptable tolerability in unresectable GCLM; HEPA-HAIC showed a favorable safety profile.