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Y90 radioembolization delays time to HCC progression vs. TACE

In a phase 2 clinical trial, the use of yttrium-90 radioembolization was more effective in prolonging time to tumor progression vs. conventional transarterial chemoembolization in patients with early intermediate hepatocellular carcinoma.

“This study represents a real-world comparative effectiveness analysis of [yttrium 90] and [conventional transarterial chemoembolization] by [intention-to-treat],” Riad Salem, MD, MBA, of the department of radiology, Northwestern University, and colleagues wrote. “[Yttrium 90] significantly increased [time-to-progression] compared with [conventional transarterial chemoembolization] … translating to significantly improved local tumor control that could reduce drop-out from transplant waitlists.”

Salem and colleagues evaluated patients with HCC of all Barcelona Clinic Liver Cancer stages between October 2009 and October 2015 and randomly assigned them to receive either a 120-Gy dose of yttrium 90 (Y90) microspheres (TheraSphere, BTG International; n = 24) or 75 mg/m² of conventional transarterial chemoembolization (cTACE; n = 21). Among all patients, 50% in the Y90 group and 71% in the cTACE group had Child-Pugh A.

The primary outcome was to determine time to progression via an intention-to-treat (ITT) analysis.

Results showed patients in the Y90 radioembolization group had longer median time-to-progression (more than 26 months) compared with patients in the cTACE group (6.8 months; P = .0012).

“This was confirmed by competing risk and inverse probability of censoring weighting analyses accounting for transplantation or death,” the researchers wrote.

The median survival time —  censored to liver transplantation — was 17.7 months for the cTACE group compared with 18.6 months for the Y90 group (P = .99).

The researchers also observed a larger portion of patients in the cTACE group compared with the Y90 group developed adverse events such as diarrhea (21% vs. 0%; P = .31) and hypoalbuminemia (58% vs. 4%; P < .001).

“With the exception of more diarrhea and hypoalbuminemia in the cTACE group, adverse events were similar between groups and compared favorably with previous retrospective reports,” the researchers wrote.

Both groups had similar overall responses to therapy; 74% in the cTACE group compared with 87% in the Y90 group (P = .433).

“Our findings have motivated an institutional change in local practice,” the researchers wrote. Patients bridged to transplantation now receive Y90 based on our finding of lower progression and potentially reduced drop-out. Therefore, Y90 may influence survival positively by increasing the rate of curative transplant.” – by Melinda Stevens

Disclosures: Salem reports advising for BTG International. Please see the full study for a list of all other researchers’ relevant financial disclosures.