TACE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TACE (TACE).
TACE (Transcatheter Arterial Chemoembolization) is not a drug but a procedure combining intra-arterial chemotherapy and embolization. Chemotherapeutic agents (e.g., doxorubicin, cisplatin) are delivered directly to tumor-feeding arteries, inducing cytotoxicity, while embolic agents (e.g., lipiodol, microspheres) occlude blood flow, causing ischemia and enhancing drug retention.
| Metabolism | Varies by chemotherapeutic agent used: doxorubicin is hepatically metabolized via CYP3A4 and aldo-keto reductases; cisplatin undergoes nonenzymatic activation and renal excretion. |
| Excretion | TACE is not a specific drug but a procedure (transarterial chemoembolization). The chemotherapeutic agents used (e.g., doxorubicin, cisplatin, mitomycin C) are typically eliminated via hepatic metabolism and biliary excretion, with renal excretion as a minor route (<10% for doxorubicin). |
| Half-life | Variable depending on the drug; for doxorubicin, terminal half-life is 24-36 hours, clinically relevant for systemic toxicity. |
| Protein binding | Doxorubicin: 70-80% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Doxorubicin: Vd 20-30 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Not applicable; TACE is intra-arterial administration with high local concentration and minimal systemic bioavailability of the chemotherapeutic agent (<10% of dose reaches systemic circulation). |
| Onset of Action | Immediate upon embolization; chemotherapeutic effect occurs over hours to days. |
| Duration of Action | Depends on drug release; embolization lasts weeks to months; chemotherapy effect persists for days to weeks. |
| Molecular Weight | 270.28 |
Transarterial chemoembolization (TACE) with doxorubicin: 50-75 mg/m² or up to 150 mg total dose, administered via hepatic artery injection, repeated every 4-6 weeks as tolerated.
| Dosage form | CAPSULE |
| Renal impairment | No specific dose adjustment required for TACE; however, contrast-induced nephropathy risk should be considered. For patients with GFR <30 mL/min, use of iodinated contrast is contraindicated; alternative imaging or pre-hydration may be needed. |
| Liver impairment | Child-Pugh A: No adjustment; Child-Pugh B: Reduce dose by 25% or consider alternative; Child-Pugh C: Contraindicated due to high risk of liver failure. |
| Pediatric use | Not established for TACE in pediatric population; use is limited to case reports. If considered, dose based on BSA with doxorubicin 25-50 mg/m² per session. |
| Geriatric use | No age-specific dose adjustment; assess hepatic and renal function as well as performance status. Use lower end of dosing range (e.g., doxorubicin 50 mg/m²) in frail patients >70 years. |
| 1st trimester | Contraindicated: increased risk of miscarriage and fetal malformations due to antimetabolite effects. |
| 2nd trimester | Contraindicated: may cause fetal growth restriction, oligohydramnios, and neonatal pancytopenia. |
| 3rd trimester | Contraindicated: risk of preterm delivery, low birth weight, and neonatal myelosuppression. |
Clinical note
Comprehensive clinical and safety monograph for TACE (TACE).
| Placental transfer | Active placental transfer, known to cross placenta and accumulate in fetal tissues; associated with teratogenicity. |
| Breastfeeding | Contraindicated during breastfeeding due to potential excretion into breast milk and severe adverse effects (e.g., myelosuppression, immunosuppression) in the nursing infant. |
| Lactation Rating |
■ FDA Black Box Warning
Not applicable (TACE is a procedure; embolic agents and chemotherapeutics used may carry their own boxed warnings; e.g., doxorubicin has black box warning for cardiotoxicity and extravasation).
| Serious Effects |
PregnancyBreastfeedingHypersensitivity to TACE or any componentSevere myelosuppression (pre-existing)
| Precautions | Hepatotoxicity, renal toxicity, post-embolization syndrome (fever, pain, nausea), tumor lysis syndrome, hepatic abscess, biliary injury, vascular injury, contrast-induced nephropathy, immunosuppression. |
| Food/Dietary | No specific dietary restrictions directly related to TACE. However, patients with underlying liver disease should adhere to a low-sodium diet if ascites is present, and avoid alcohol completely. Maintain adequate protein intake unless encephalopathy is a concern. |
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| L5 |
| Teratogenic Risk | TACE refers to transarterial chemoembolization, a locoregional therapy using chemotherapy agents (e.g., doxorubicin, cisplatin) and embolic agents. All agents are contraindicated in pregnancy. First trimester: high risk of teratogenicity (neural tube defects, cardiac malformations) due to antimitotic effects. Second/third trimesters: risk of fetal growth restriction, preterm birth, and neonatal myelosuppression. Absolute contraindication during pregnancy. |
| Fetal Monitoring | Pre-procedure: confirm negative pregnancy test. During: maternal monitoring of vital signs, hepatic/renal function, coagulation panel, and signs of postembolization syndrome (fever, pain, nausea). Fetal monitoring not applicable as procedure is contraindicated in pregnancy. |
| Fertility Effects | Chemotherapeutic agents (e.g., doxorubicin) can cause gonadal toxicity: ovarian failure (amenorrhea, elevated FSH) and azoospermia. Risk is dose- and age-dependent. May lead to permanent infertility. Pre-procedure fertility preservation counseling recommended. |
| Clinical Pearls | TACE (Transarterial Chemoembolization) is a locoregional therapy for hepatocellular carcinoma (HCC). Key pearls: (1) Child-Pugh class A or select B7 patients are optimal candidates; (2) Post-embolization syndrome (fever, pain, nausea) is common and self-limited; (3) Assess portal vein patency—complete portal vein thrombosis is a relative contraindication; (4) Use lipiodol as a drug carrier and embolic agent; (5) Repeat on demand based on imaging (mRECIST criteria) every 4-6 weeks. |
| Patient Advice | You may experience abdominal pain, fever, and nausea for a few days after the procedure. · Avoid heavy lifting and strenuous activity for at least one week. · Report any signs of infection (worsening pain, chills) or bleeding immediately. · You will need imaging follow-up to assess treatment response. · Do not drive or operate machinery for 24 hours after sedation. |