• liver
• cancer

Hepatocellular carcinoma (HCC) represents a serious health problem, mainly due to the high cancer-related mortality. Transarterial chemoembolisation (TACE) is currently used as the first-line treatment for intermediate-stage HCC (Barcelona Clinic Liver Cancer (BCLC) stage B), despite the fact that this stage comprises patients with a wide range of liver function, variable tumour number and size.1–4 In clinical practice, only 50%–60% of patients with BCLC stage B benefit from TACE, so TACE is usually repeated to achieve maximum tumour recession. The main factors that impact the effectiveness of TACE include the worsening of both the liver function and recurrence rate. The latter is the result of the angiogenic response triggered by TACE-induced hypoxia, which stimulates residual tumour growth.5 This has led to the concept that combining TACE with an antiangiogenic treatment such as sorafenib will offer better tumour control.6 During the last decade, this hypothesis was tested in several trials, but the results were inconsistent.7–10 According to a recent meta-analysis the combination of TACE plus sorafenib for unresectable HCC was superior in terms of time to progression but not in overall survival (OS).11

In Gut, a new trial combining TACE with sorafenib, the TACTICS trial, is published.12 The authors report that in patients with BCLC stage B, the progression-free survival (PFS), which was 13 months with TACE alone, reached 25 months with the addition of sorafenib to TACE. Similarly, the time to untreatable (unTACEable) progression increased significantly from 21 …