[11] The use of BCAA granules was identified as a contributing factor to prolonged survival in a multivariate analysis.[11] The mechanism of the inhibitory effect of BCAA granules against HCC recurrence after RFA needs to be verified in a large-scale prospective
study. BCAA granules may inhibit HCC recurrence in patients who have undergone percutaneous RFA as well as in those who have undergone hepatectomy.[11, 29] Transcatheter arterial chemoembolization is a combination of local chemotherapy through feeding blood vessels and the use of AP24534 concentration embolizing material.[16, 84-87] TACE is most frequently used for the treatment of HCC in Japan, where it was originally developed.[84, 87-90] EASL guidelines recommend TACE for unresectable, Child–Pugh class A or B multiple HCC with no vascular invasion, whereas in Japan the therapy is recommended even for HCC with vascular invasion if it is Vp1 or Vp2.[50, 51] The Talazoparib purchase factors affecting the survival of HCC patients treated with TACE are: (i) tumor stage; (ii) tumor markers; and (iii) hepatic functional reserve.[84] Preserving hepatic functional reserve is a critical issue in HCC patients who, in general, are treated repeatedly with TACE.[16, 88-92] However, in some patients, hepatic functional reserve decreases after TACE
because of complications such as post-TACE syndrome.[93] The usefulness of BCAA granules or BCAA-enriched “snacks” for patients with unresectable HCC treated with TACE has been suggested in several studies.[16, 91, 92] In a randomized controlled trial (RCT) in 56 HCC patients treated with TACE, Takeshita et al. found that the post-TACE decrease
in liver function was suppressed significantly in patients who received an enteral nutritional formula for hepatic failure given as a late-evening snack (LES) compared with the control group.[91, 94] Our retrospective controlled study in 99 HCC patients treated with TACE showed that therapy using BCAA granules significantly inhibited the decrease in hepatic functional reserve at 3 months and 6 months 上海皓元医药股份有限公司 compared with the regular diet group.[16] According to EASL guidelines, if HCC with Child–Pugh class B treated with TACE recurs as Child–Pugh class C, TACE is not indicated for the recurred HCC. The significance of therapy using BCAA granules is considerable in terms of permitting repeated TACE. There had long been a lack of evidence to support systemic chemotherapy for unresectable advanced HCC.[95] However, after the efficacy of a molecular-targeted drug, sorafenib, for unresectable advanced HCC was demonstrated in two RCT (SHARP trial and Asia–Pacific trial), the drug was approved for the treatment of unresectable advanced HCC in Japan in 2009.