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

• Published in: Journal of hepatocellular carcinoma Vol. 7; pp. 117 - 131
• Main Authors: Teyateeti, Ajalaya, Mahvash, Armeen, Long, James P, Abdelsalam, Mohamed E, Avritscher, Rony, Chasen, Beth, Kaseb, Ahmed O, Kuban, Joshua D, Murthy, Ravi, Odisio, Bruno C, Teyateeti, Achiraya, Macapinlac, Homer A, Kappadath, S Cheenu
• Format: Journal Article
• Language: English
• Published: New Zealand Taylor & Francis Ltd 01.01.2020; Dove; Dove Medical Press
• Subjects: adverse events; Ascites; Cancer therapies; Contraindications; Disease; Dosimetry; Hepatocellular carcinoma; Laboratories; Liver cancer; Medical imaging; Medical prognosis; Metastasis; Multivariate analysis; Original Research; Patients; prognostic factors; selective internal radiation therapy; Survival; Targeted cancer therapy; therasphere; Tumors; y90; Yttrium; 90Y; prognostic factors; adverse events; selective internal radiation therapy; TheraSphere
• ISSN: 2253-5969; 2253-5969
• DOI: 10.2147/JHC.S248314

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. 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. 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, =0.02) in TARE_alone, and IHT ≤50% (HR 0.39, =0.004) and AFP <400 (HR 0.5, =0.027) in TARE_sorafenib. Unilobar involvement (HR 0.43, =0.029) and AFP <400 ng/mL (HR 0.52, =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. 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.