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

Authors Teyateeti A, Mahvash A, Long JP, Abdelsalam ME, Avritscher R, Chasen B, Kaseb AO, Kuban JD, Murthy R, Odisio BC, Teyateeti A, Macapinlac HA, Kappadath SC

Received 4 February 2020

Accepted for publication 21 July 2020

Published 14 September 2020 Volume 2020:7 Pages 117—131

DOI https://doi.org/10.2147/JHC.S248314

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Dan Duda


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 Kappadath7

1Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 3Department of Interventional Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 4Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 5Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; 6Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 7Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Correspondence: S Cheenu Kappadath
Department of Imaging Physics, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1155 Pressler Street — Unit 1352, Houston, TX 77030, USA
Tel +1 713 745 2835
Email skappadath@mdanderson.org

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, selective internal radiation therapy, TheraSphere, prognostic factors, adverse events

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