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. 2024 Apr;41(4):1606-1620.
doi: 10.1007/s12325-024-02800-5. Epub 2024 Feb 26.

Selective Internal Radiation Therapy Using Y-90 Resin Microspheres for Metastatic Colorectal Cancer: An Updated Systematic Review and Network Meta-Analysis

André L F Azeredo-da-Silva  1   2 , Victor Hugo F de Jesus  3 , Ion Agirrezabal  4 , Victoria K Brennan  5 , Phuong L Carion  4 , Nathalie Amoury  4 , Bruna M Vetromilla  6 , Bruna S Zanotto  6 , Suki Shergill  5 , Patricia K Ziegelmann  7   8
Affiliations

Selective Internal Radiation Therapy Using Y-90 Resin Microspheres for Metastatic Colorectal Cancer: An Updated Systematic Review and Network Meta-Analysis

André L F Azeredo-da-Silva et al. Adv Ther. 2024 Apr.

Abstract

Introduction: This literature review and exploratory network meta-analysis (NMA) aimed to compare the clinical effectiveness and tolerability of selective internal radiation therapy (SIRT) using yttrium-90 (Y-90) resin microspheres, regorafenib (REG), trifluridine-tipiracil (TFD/TPI), and best supportive care (BSC) in adult patients with chemotherapy-refractory or chemotherapy-intolerant metastatic colorectal cancer (mCRC).

Methods: In light of recently published data, the literature was searched to complement and update a review published in 2018. Studies up to December 2022 comparing two or more of the treatments and reporting overall survival (OS), progression-free survival (PFS), or incidence of adverse events (AE) were included. The NMA compared hazard ratios (HRs) for OS and PFS using Markov chain Monte Carlo techniques.

Results: Fifteen studies were included, with eight studies added (none addressing SIRT). All active treatments improved OS in relation to BSC. SIRT had the longest OS among all treatments, although without statistically significant differences (HR [95% credible interval] for SIRT, 0.48 [0.27, 0.87]; TFD/TPI, 0.62 [0.46, 0.83]; REG, 0.78 [0.57, 1.05]) in a fixed effects model. Information regarding SIRT was insufficient for PFS analysis, and TFD/TPI was the best intervention (HR 2.26 [1.6, 3.18]). One SIRT study reported radioembolization-induced liver disease in > 10% of the sample; this was symptomatically managed. Non-haematological AEs (hand-foot skin reaction, fatigue, diarrhoea, hypertension, rash or desquamation) were more common with REG, while haematological events (neutropoenia, leukopenia, and anaemia) were more common with TFD/TPI.

Conclusion: Current evidence supports SIRT treatment in patients with chemotherapy-refractory or chemotherapy-intolerant mCRC compared to newer oral agents, with comparable OS and low incidence of AEs.

Keywords: Best supportive; Liver metastasis; Regorafenib; SIRT; Trifluridine–tipiracil.

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Conflict of interest statement

Ion Agirrezabal was affiliated with Sirtex Medical at the time of the study. They now work for Sanofi. Victoria K. Brennan was affiliated with Sirtex Medical at the time of the study. They now work for Open Health. Phuong L. Carion was a Sirtex Medical employee at the time of the analysis. Nathalie Amoury was a Sirtex Medical employee at the time of the analysis. Suki Shergill was a Sirtex Medical employee at the time of the analysis. Bruna S. Zanotto was working on behalf of Sirtex Medical on the project. Bruna M. Vetromilla was working on behalf of Sirtex Medical on the project. André L. F. Azeredo-da-Silva was working on behalf of Sirtex Medical on the project. Patricia K. Ziegelmann was working on behalf of Sirtex Medical on the project. Victor Hugo F. de Jesus has received honoraria for academic purposes and consulting for Sirtex.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for the study selection process. aMEDLINE and EMBASE searches were made simultaneously in the embase.com search engine. bRecords excluded after assessment of title and abstract with the justification of not addressing the research question. Adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71
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