Bilobar Radioembolization Carries the Risk of Radioembolization-Induced Liver Disease in the Treatment of Advanced Hepatocellular Carcinoma: Safety and Efficacy Comparison to Systemic Therapy with Atezolizumab/Bevacizumab

• Published in: Cancers Vol. 15; no. 17; p. 4274
• Main Authors: Jeschke, Matthias, Ludwig, Johannes M, Leyh, Catherine, Pabst, Kim M, Weber, Manuel, Theysohn, Jens M, Lange, Christian M, Herrmann, Ken, Schmidt, Hartmut H-J, Jochheim, Leonie S
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 26.08.2023; MDPI
• Subjects: Ablation; Ascites; Bevacizumab; Cancer therapies; Care and treatment; Chemotherapy; Cirrhosis; Development and progression; Disease control; Hepatocellular carcinoma; Hepatoma; Immune checkpoint inhibitors; Liver cancer; Liver cirrhosis; Liver diseases; Normal distribution; Patients; Protein-tyrosine kinase; Radiation; Risk factors; Safety; Statistical analysis; Survival; Toxicity; Yttrium; Germany; systemic treatment; Yttrium-90; hepatotoxicity; bevacizumab; radioembolization; REILD; atezolizumab; immune checkpoint inhibitors; ALBI; hepatocellular carcinoma
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15174274

Recommended treatment options for advanced-stage hepatocellular carcinoma (HCC) include systemic therapy (ST) and trans-arterial radioembolization (TARE) with Yttrium-90 (Y90). Before the approval of immune-checkpoint inhibitors, a similar safety profile was reported for TARE and ST with tyrosine kinase inhibitors (TKI). However, whole-liver treatment and underlying cirrhosis were identified as risk factors for potentially lethal radioembolization-induced liver disease (REILD). Therefore, the safety and efficacy of TARE and ST with atezolizumab/bevacizumab were compared in patients with advanced HCC involving at least both liver lobes in a retrospective real-world cohort. In total, 74 patients with new or recurrent advanced-stage HCC (BCLC stage B/C) were included if treated with either bilobar TARE (n = 33) or systemic combination therapy with atezolizumab plus bevacizumab (n = 41). Most patients had compensated liver function (90.5% were classified as Child-Pugh Score A, 73% as ALBI Grade 1) at baseline. Although not significant, patients treated with ST showed a more prolonged overall survival than those treated with Y90 TARE (7.1 months vs. 13.0 months, = 0.07). While a similar disease control rate could be achieved with bilobar TARE and atezolizumab/bevacizumab, in the TARE group, overall survival was curtailed by the occurrence of REILD. In patients with underlying liver cirrhosis, the liver function at baseline was a predictor for REILD.