TACE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TACE (TACE).

How it works

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.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TACE (TACE).

Breastfeeding

Chemotherapeutic agents used in TACE (e.g., doxorubicin, cisplatin) are excreted into breast milk. M/P ratio not established. Because of potential severe adverse effects (immunosuppression, neutropenia, carcinogenesis) in the nursing infant, breastfeeding is contraindicated during and for at least 2 weeks after the procedure.

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.

Warnings & precautions

■ 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).

Side Effect Profile

Serious Effects

Absolute Contraindications

Decompensated cirrhosis (Child-Pugh C), severe liver dysfunction, portal vein thrombosis (relative), uncontrolled infection, renal insufficiency (depending on chemotherapeutic), contrast allergy, uncorrectable coagulopathy.

Clinical Precautions

Precautions

Hepatotoxicity, renal toxicity, post-embolization syndrome (fever, pain, nausea), tumor lysis syndrome, hepatic abscess, biliary injury, vascular injury, contrast-induced nephropathy, immunosuppression.

Clinical Tips & Counseling

Drug interactions

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TACE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TACE (TACE).

How it works

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TACE (TACE).

Breastfeeding

Teratogenic Risk

Warnings & precautions

■ 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).