TAE and cTACE Show Comparable Efficacy for Liver-Dominant Neuroendocrine Tumor Metastases
At the NANETs 2025 Multidisciplinary NET Medical Symposium, results from a large international randomized trial comparing transarterial embolization (TAE) and 2 forms of chemoembolization (cTACE and DEB-TACE) for liver-dominant neuroendocrine tumor (NET) metastases showed comparable efficacy between TAE and cTACE but highlighted increased toxicity associated with bland embolization.
For decades, both TAE and TACE have been used to manage unresectable or progressive liver metastases from NETs, yet guidelines have not specified a preferred approach. This pragmatic, multicenter trial sought to clarify relative outcomes among embolization techniques in a real-world, international setting.
Between 2017 and 2022, 151 patients were randomized to TAE (n = 78) or cTACE (n = 73) after the DEB-TACE arm was closed early due to safety concerns. The study included participants across 13 centers in North and South America and Europe. Most patients had midgut (54%) or pancreatic (36%) primaries, with predominantly grade 1 or 2 disease. Nearly all had received prior somatostatin analog therapy, and 28% had undergone previous liver-directed interventions.
At baseline, demographics and disease characteristics were balanced between treatment groups. The primary end point, hepatic progression-free survival (HPFS) by blinded independent central review, did not differ significantly between arms: hazard ratio (HR) 1.40 (95% confidence interval [CI], 0.80 to 2.46; P = .234). Overall PFS was also similar (HR, 1.43; 95% CI, 0.90 to 2.26; P = .133).
However, safety outcomes varied notably. Serious complications (SIR Class D to E) occurred in 44% of TAE patients and 29% of cTACE patients, while Common Terminology Criteria for Adverse Events (CTCAE) grade 3 to 4 toxicities were reported in 54% and 36%, respectively. The DEB-TACE cohort was discontinued after early review revealed a 40% serious adverse event rate, exceeding the 20% prespecified safety threshold.
Investigators concluded that TAE and cTACE offer equivalent efficacy for managing NET liver metastases, but the higher incidence of severe toxicity with TAE warrants caution. DEB-TACE, due to its unfavorable safety profile, should be avoided in this patient population.
Source:
Soulen MC, Wileyto EP, Dey C, et al. Randomized Embolization Trial for NeuroEndocrine Tumors (RETNET). Presented at the NANETs 2025 Multidisciplinary NET Medical Symposium; October 23-25, 2025. Austin, Texas. Abstract ID 33254
