Comparison between Y90 Radioembolization Plus Sorafenib and Y90 Radioembolization alone in the Treatment of Hepatocellular Carcinoma: A Propensity Score Analysis

Abstract

Background: Adjuvant sorafenib may enhance the efficacy of transarterial radioembolization with yttrium-90 in hepatocellular carcinoma patients. The aim of this study is to assess the efficacy and safety of radioembolization plus sorafenib in comparison to radioembolization alone. Methods: Out of 175 hepatocellular carcinoma (HCC) patients treated with radioembolization between 2011 and 2018, after propensity score matching, two groups were compared: a group of 45 patients that underwent radioembolization while being on sorafenib (Group 1) and a second group of 90 patients that underwent radioembolization alone (Group 2). Results: Baseline characteristics of the two groups were well balanced concerning liver function and tumor burden. No significant differences in survival outcomes were identified (median overall survival 10 vs. 10 months; p = 0.711), median progression-free survival 6 vs. 7 months (p = 0.992) in Group 1 and Group 2). The objective response rate in Group 1 vs. Group 2 was 45.5% vs. 42.8% (p = 1) according to mRECIST. No differences in toxicity nor in liver decompensation rates were registered. Conclusions: The association of sorafenib does not prolong survival nor delay progression in patients treated with radioembolization. Liver toxicity does not differ among the two therapeutic schemes.

Modeling Hepatocellular Carcinoma Cells Dynamics by Serological and Imaging Biomarkers to Explain the Different Responses to Sorafenib and Regorafenib

“…In addition, it is not possible to establish whether the acceleration of the natural decay of the existing vasculature, suggested by the modeling analysis in CR, was due solely to sorafenib or to other concomitant conditions. In Case 1, for instance, tumor shrinkage was accompanied by complete atrophy of the left liver lobe, and we cannot rule out that the left branch portal vein thrombosis ( Figure 1 ) and the previous TARE may have played a role in tumor de-vascularization obtained by systemic treatment [ 32 , 33 ]. Overall, portal vein thrombosis was present in half of the patients analyzed, and we cannot exclude the possibility that changes of liver hemodynamics could have interfered on model parameters.…”

“…Among 112 patients, who received for at least 3 months of TKI treatment for BCLC-B (33) or BCLC-C (79) HCC at the Hepatology Unit of the Azienda Ospedaliera-Universitaria Pisana from 2007, we initially identified three cases who had clinically relevant responses and sufficient imaging and serological data for developing the mathematical model: Case-1 with CR to sorafenib, Case-2 with partial response to sorafenib and Case-3 with PR to regorafenib. Their detailed clinical features and the modeling analysis are reported in the Results section.…”

Radioembolization in the Setting of Systemic Therapies

“…6 In a retrospective propensity score analysis, the outcomes of HCC patients (BCLC B-C) who received Y90 only (n ¼ 90) were compared with those who received sorafenib plus Y90 (n ¼ 45). 7 In the combined group, the median time on sorafenib prior to Y90 was 2 months, for a total median duration of therapy of approximately 9 months. The median daily dose of sorafenib was 800 mg.…”

The multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus

“…Based (32,33). As to the combination of sorafenib with TARE, a retrospective study suggested that no significant differences in survival outcomes were identified between sorafenib plus TARE and TARE monotherapy (median overall survival 10 vs. 10 months; p = 0.711) (34). Albeit the uncertainty of www.biosciencetrends.com BioScience Trends Advance Publication P4 vein invasion accounted for 55% and 23% of patients with HCC in the China cohort, respectively (37).…”