Chronic Hepatotoxicity in Patients with Metastatic Neuroendocrine Tumor: Transarterial Chemoembolization versus Transarterial Radioembolization

Currie, B.; Nadolski, Gregory J.; Mondschein, Jeffrey I.; Dagli, Mandeep; Sudheendra, Deepak; Stavropoulos, S. William; Soulen, Michael C.

doi:10.1016/j.jvir.2020.05.019

Cited by 19 publications

(13 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Currie et al reviewed incidence of chronic hepatitis following treatment of 91 patients: 63 and 28 underwent chemoembolization and TARE, respectively. The incidence of grade 3 toxicities attributable to treatment with TARE (14%) and chemoembolization (3%) did not reach statistical significance, potentially due to sample size [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes following 90Y Radioembolization of neuroendocrine liver metastases: evaluation of the radiation-emitting SIR-spheres in non-resectable liver tumor (RESiN) registry

et al. 2022

View full text Add to dashboard Cite

Background The goal of this study was to evaluate efficacy and safety of 90Y radioembolization for neuroendocrine liver metastases (NELM) in a multicenter registry. Methods One hundred-seventy patients with NELM were enrolled in the registry (NCT 02685631). Prior treatments included hepatic resection (n = 23, 14%), arterial therapy (n = 62, 36%), octreotide (n = 119, 83%), cytotoxic chemotherapy (n = 58, 41%), biologic therapy (n = 49, 33%) and immunotherapy (n = 10, 6%). Seventy-seven (45%) patients had extrahepatic disease. Seventy-eight (48%), 61 (37%), and 25 (15%) patients were Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or ≥ 2. Tumor grade was known in 81 (48%) patients: 57 (70%) were well-, 12 (15%) moderate-, and 12 (15%) poorly-differentiated. Kaplan-Meier analysis and log rank tests were performed to compare overall and progression-free survival (OS/PFS) by tumor location and grade. Toxicities were reported using Common Terminology Criteria for Adverse Events v.5. Cox Proportional Hazards were calculated for pancreatic primary, performance status, extrahepatic disease at treatment, unilobar treatment, baseline ascites, and > 25% tumor burden. Results One, 2, and 3-year OS rates were 75, 62 and 46%, respectively. Median OS was 33 months [(95% CI: 25-not reached (NR)]. The longest median OS was in patients with pancreatic (42 months, 95% CI: 33-NR) and hindgut 41 months, 95% CI: 12-NR) primaries. The shortest OS was in foregut primaries (26 months; 95% CI: 23-NR; X2 = 7, p = 0.1). Median OS of well-differentiated tumors was 36 months (95% CI: 10-NR), compared to 44 (95% CI: 7-NR) and 25 (95% CI: 3-NR) months for moderate and poorly differentiated tumors. Median progression-free survival (PFS) was 25 months with 1, 2, and 3-year PFS rates of 70, 54, and 35%, respectively. Thirteen patients (7.6%) developed grade 3 hepatic toxicity, most commonly new ascites (n = 8, 5%) at a median of 5.5 months. Performance status of ≥2 (HR 2.7, p = 0.01) and baseline ascites (HR 2.8, P = 0.049) predicted shorter OS. Discussion In a population with a high incidence of extrahepatic disease, 90Y was effective and safe in treatment of NELM, with median OS of 41 months for well differentiated tumors. Grade 3 or greater hepatic toxicity was developed in 7.6% of patients. Trial registration NCT 02685631.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term outcomes following 90Y Radioembolization of neuroendocrine liver metastases: evaluation of the radiation-emitting SIR-spheres in non-resectable liver tumor (RESiN) registry

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Also, therapeutic synergism between radiation and immune checkpoint blockade has been suggested by preclinical studies, and a recent study showed 30.6% objective response according to RECIST after RE followed by nivolumab [34]. Considering the importance of liver function in the outcome of HCC patients, RE-induced liver disease has been described as deterioration in liver function at 4-8 weeks [35], and recent findings suggest RE may cause a delayed subclinical liver damage presenting with liver decompensation at 6 months [36]. Additionally, a sub-analysis of SORAMIC patients has shown that patients who received RE in addition to sorafenib had a higher increase in ALBI scores at 4 and 6 months compared to patients who received only sorafenib [37].…”

Section: Discussionmentioning

confidence: 99%

Addition of Y-90 radioembolization increases tumor response and local disease control in hepatocellular carcinoma patients receiving sorafenib

Öcal

Schütte

Zech

et al. 2022

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose To compare the treatment response and progression-free survival (PFS) in advanced hepatocellular carcinoma (HCC) patients who received sorafenib treatment either alone or combined with radioembolization (RE). Methods Follow-up images of the patients treated within a multicenter phase II trial (SORAMIC) were assessed by mRECIST. A total of 177 patients (73 combination arm [RE + sorafenib] and 104 sorafenib arm) were included in this post-hoc analysis. Response and progression characteristics were compared between treatment arms. Survival analyses were done to compare PFS and post-progression survival between treatment arms. Multivariate Cox regression analysis was used to compare survival with factors known to influence PFS in patients with HCC. Results The combination arm had significantly higher objective response rate (61.6% vs. 29.8%, p < 0.001), complete response rate (13.7% vs. 3.8%, p = 0.022), and a trend for higher disease control rate (79.2% vs. 72.1%, p = 0.075). Progression was encountered in 116 (65.5%) patients and was more common in the sorafenib arm (75% vs. 52.0%, p = 0.001). PFS (median 8.9 vs. 5.4 months, p = 0.022) and hepatic PFS were significantly better in the combination arm (9.0 vs. 5.7 months, p = 0.014). Multivariate analysis confirmed the treatment arm as an independent predictor of PFS. Conclusion In advanced HCC patients receiving sorafenib, combination with RE has an additive anticancer effect on sorafenib treatment resulting in a higher and longer tumor response. However, the enhanced response did not translate into prolonged survival. Better patient selection and superselective treatment could improve outcomes after combination therapy.

show abstract

“…Long-term toxicity, and in particular, long hepatotoxicity is an area of scientific debate has a lack of proper evidence [ 32 , 33 , 34 ]. Mainly in North America, concerns were raised due to suggested long-term hepatotoxicity, showing as cirrhosis-like morphology on imaging studies without clinical complaints.…”

Section: Concerns Limitations and Future Perspectivesmentioning

confidence: 99%

“…Unfortunately, these small studies could not be confirmed in the larger retrospective studies or in the prospective study by Braat et al [ 9 , 28 ]. In a recent single center study, long-term hepatotoxicity was compared between patients treated with TACE and radioembolization, and no significant difference was encountered (22% vs. 29%, respectively) [ 32 ]. One may wonder whether this ‘problem’ is truly a concern.…”

Section: Concerns Limitations and Future Perspectivesmentioning

confidence: 99%

The Evolving Role of Radioembolization in the Treatment of Neuroendocrine Liver Metastases

Ramdhani

Braat

2022

Cancers

View full text Add to dashboard Cite

At diagnosis, 21–50% of neuroendocrine tumors already have distant metastases, of which the liver is most commonly affected. Unfortunately, the presence of neuroendocrine liver metastases (NELM) is the most incriminating factor for survival. At NELM diagnosis, 60–70% of patients suffer from bilobar multifocal disease, making them ineligible for surgical resection. With limited systemic options, a clinical need for liver-directed treatments exists. Trans-arterial (bland) embolization, chemoembolization and radioembolization have been increasingly used in the treatment of NELM. In recent years, radioembolization (also known as selective internal radiation therapy) has gained attention due to promising tumor reductive results, limited toxicities and increasing scientific evidence. This review provides basic insights into radioembolization as a technique, a summary of available literature on radioembolization in NELM, and discusses caveats, challenges and new insights when considering radioembolization in NELM.

show abstract

Chronic Hepatotoxicity in Patients with Metastatic Neuroendocrine Tumor: Transarterial Chemoembolization versus Transarterial Radioembolization

Cited by 19 publications

References 22 publications

Long-term outcomes following 90Y Radioembolization of neuroendocrine liver metastases: evaluation of the radiation-emitting SIR-spheres in non-resectable liver tumor (RESiN) registry

Long-term outcomes following 90Y Radioembolization of neuroendocrine liver metastases: evaluation of the radiation-emitting SIR-spheres in non-resectable liver tumor (RESiN) registry

Addition of Y-90 radioembolization increases tumor response and local disease control in hepatocellular carcinoma patients receiving sorafenib

The Evolving Role of Radioembolization in the Treatment of Neuroendocrine Liver Metastases

Contact Info

Product

Resources

About