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. 2020 Sep 14:7:117-131.
doi: 10.2147/JHC.S248314. eCollection 2020.

Survival Outcomes for Yttrium-90 Transarterial Radioembolization With and Without Sorafenib for Unresectable Hepatocellular Carcinoma Patients

Ajalaya Teyateeti  1   2 , Armeen Mahvash  3 , James P Long  4 , Mohamed E Abdelsalam  3 , Rony Avritscher  3 , Beth Chasen  1 , Ahmed O Kaseb  5 , Joshua D Kuban  3 , Ravi Murthy  3 , Bruno C Odisio  3 , Achiraya Teyateeti  6 , Homer A Macapinlac  1 , S Cheenu Kappadath  7
Affiliations

Survival Outcomes for Yttrium-90 Transarterial Radioembolization With and Without Sorafenib for Unresectable Hepatocellular Carcinoma Patients

Ajalaya Teyateeti et al. J Hepatocell Carcinoma. .

Abstract

Purpose: To assess the overall survival (OS) and progression-free survival (PFS) of unresectable hepatocellular carcinoma (HCC) patients undergoing yttrium-90 glass-microsphere transarterial radioembolization (TARE) with and without concurrent sorafenib.

Methods: OS and PFS were analyzed in 55 patients with an intrahepatic tumor (IHT) ≤50% without advanced or aggressive disease features (ADFs), which was referred to presence of infiltrative/ill-defined HCC, macrovascular invasion, or extrahepatic disease treated with only TARE (TARE_alone) and in 74 patients with IHT ≤50% with ADFs or IHT >50% treated with TARE and sorafenib (TARE_sorafenib). Prognostic factors for OS and PFS were identified using univariate and multivariate analyses.

Results: Median OS and PFS of TARE_alone patients were 21.6 (95% CI 6.1-37.1) and 9.1(95% CI 5.2-13.0) months, respectively, and for TARE_sorafenib patients 12.4 (95% CI 9.1-15.6) and 5.1 (95% CI 2.6-7.5) months, respectively. Better OS was associated with serum AFP <400 (HR 0.27, p=0.02) in TARE_alone, and IHT ≤50% (HR 0.39, p=0.004) and AFP <400 (HR 0.5, p=0.027) in TARE_sorafenib. Unilobar involvement (HR 0.43, p=0.029) and AFP <400 ng/mL (HR 0.52, p=0.015) correlated with better PFS in TARE_alone and TARE_sorafenib, respectively. Adverse events (AEs) were more frequent in TARE_sorafenib than TARE_alone (92.4 vs 80.3%), but only 9.3% were grade 3 or higher AEs.

Conclusion: TARE_alone provided the most prominent survival benefit in IHT ≤50%-without ADF patients who had unilobar HCC and serum AFP <400 ng/mL. TARE and sorafenib yielded the best outcomes in patients with IHT ≤50% and serum AFP <400 ng/mL, with some additional grade 1-2 AEs compared to TARE only.

Keywords: 90Y; TheraSphere; adverse events; prognostic factors; selective internal radiation therapy.

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Conflict of interest statement

AM has received research grants from BTG International, Sirtex Medical, and ABK Medical and serves as a consultant for BTG, Sirtex, and Boston Scientific. JDK has received a research grant from Cynvenio Biosystems and is on a speaker bureau of Angiodynamics. He reports personal fees from BTG and Argon, and serves on an advisory board for Boston Scientific. BC serves on an advisory board for Advanced Accelerator Applications and Clovis Oncology. BCO. has received a research grant from Siemens Healthineers and serves as a consultant for Koo Foundation. SCK has received research grants from BTG International and GE Healthcare and serves as a consultant for BTG International, Terumo Medical, Sirtex Medical, and ABK Biomedical. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Kaplan-Meier curves stratified by prognostic factors showing, significantly longer OS durations for the (A) TARE_ alone subgroup with AFP <400 ng/mL and (B) TARE_sorafenib subgroup with intrahepatic tumor ≤50%, and longer median PFS durations for the (C) TARE_alone subgroup with unilobar involvement and (D) TARE_sorafenib subgroup with AFP <400 ng/mL.
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