Highlighting Survival with Yttrium-90 Radioembolization Therapy in Unresectable Hepatocellular Carcinoma

Nabrinsky, Edward; James, Edward

doi:10.7759/cureus.8163

Cited by 4 publications

(7 citation statements)

References 19 publications

(34 reference statements)

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“…15 Sorafenib, an antiangiogenic agent, also normalizes tumor vasculature and improves the delivery of oxygen to the tumor which complements the immunogenic effect of Y90 radioembolization. 10 The main limitation of our study is the small reported number of HCC patients with HV or IVC invasion that have undergone Y90-systemic combination therapy. Moreover, the optimal interval and dosage of sorafenib or nivolumab when used with Y90 radioembolization have not been fully explored.…”

Section: Discussionmentioning

confidence: 91%

Review of outcomes of combination therapy using yttrium 90 radioembolization and sorafenib/nivolumab for HCC with hepatic vein or IVC invasion

Chung

Gogna

Chandramohan

et al. 2023

Proceedings of Singapore Healthcare

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Background A systematic review of the outcomes of combination therapy using Yttrium 90 radioembolization (Y90) and sorafenib/nivolumab for patients with hepatocellular carcinoma (HCC), with hepatic vein (HV) or inferior vena cava (IVC) invasion. The aim of this study is to summarise the results of different studies that used the combination therapy for HCC patients with tumor thrombosis involving the HV or IVC. Method A literature search was performed using keywords in Medline and Google Scholar limited to publications from 2010 to 2021. There were 173 articles identified during the initial literature search. During abstract screening, 81 articles were excluded. Another 83 did not contain information on hepatic vein or IVC invasion. Therefore, 9 articles met the eligibility criteria and were included in the synthesis. Results In total, 37 patients with hepatic vein or IVC invasion were identified. There were 31 patients who were given sorafenib, 7 were given nivolumab and 1 was given both sorafenib and nivolumab. Among the 37 patients, 21 had hepatic vein invasion, 22 had IVC invasion and 6 had both HV and IVC invasion. The median OS was 20.55 months and median PFS was 8.18 months. For the results, 23 patients were evaluated via modified RECIST (mRECIST) criteria and 14 were evaluated via RECIST 1.1. Conclusion The combination of local and systemic therapies demonstrated potential results for increased response rates, OS and PFS benefits. Further studies are required to determine the long-term outcomes of the combination therapy for this group of patients.

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Section: Discussionmentioning

confidence: 91%

Review of outcomes of combination therapy using yttrium 90 radioembolization and sorafenib/nivolumab for HCC with hepatic vein or IVC invasion

Chung

Gogna

Chandramohan

et al. 2023

Proceedings of Singapore Healthcare

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“…This included 11 clinical trials (4 randomized and 7 nonrandomized) and 8 cohort studies (Table 1), 12 case series, and 32 case reports (supplemental online Table 3). Fifty of the articles described the use of immunotherapy agents in the setting of unresectable HCC [13, 14, 18, 29–75], 3 in the neoadjuvant setting [76–78], and 10 in the setting of LT [79–88], and they reported on 2,402 patients in total (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…The mean score of the NHBLI scale for the case series [31, 32, 37, 39, 40, 44, 51, 62, 67, 77, 80, 84] was 6.8 ± 0.9 (supplemental online Table 6). The mean score of the JBI scale for the case reports [29, 33, 34, 38, 41, 43, 46–50, 52, 55, 61, 64, 65, 68, 69, 71, 72, 74–76, 78, 79, 81–83, 85–88] was 7.2 ± 1.1 (supplemental online Table 7). These results highlight that the included studies were of high quality on average.…”

Section: Resultsmentioning

confidence: 99%

The Role of Immunotherapy in Hepatocellular Carcinoma: A Systematic Review and Pooled Analysis of 2,402 Patients

Ziogas

Evangeliou²,

Giannis

et al. 2021

The Oncologist

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Background. Immune checkpoints inhibitors (ICIs) have emerged as a treatment option for several malignancies. Nivolumab, pembrolizumab, nivolumab plus ipilimumab, and atezolizumab plus bevacizumab have been approved for the management of advanced-stage hepatocellular carcinoma (HCC). We aimed to systematically review the literature and summarize the characteristics and outcomes of patients with HCC treated with ICIs. Methods. A systematic literature search of PubMed, the Cochrane Library, and ClinicalTrials.gov was performed according to the PRISMA statement (end of search date: November 7, 2020). Quality of evidence assessment was also performed. Results. Sixty-three articles including 2,402 patients were analyzed, 2,376 of whom received ICIs for unresectable HCC. Response to ICIs could be evaluated in 2,116 patients; the overall objective response rate (ORR) and disease control rate (DCR) were 22.7% and 60.7%, respectively, and the mean overall survival (OS) was 15.8 months. The ORR, DCR, and OS for nivolumab (n = 846) were 19.7%, 51.1%, and 18.7 months, respectively; for pembrolizumab (n = 435) they were 20.7%, 64.6% and 13.3 months, respectively. The combination of atezolizumab/bevacizumab (n = 460) demonstrated an ORR and DCR of 30% and 77%, respectively. The overall rate of treatment discontinuation because of adverse events was 14.9%. Fifteen patients received ICIs in the liver transplant (LT) setting (one pre-LT for bridging, 14 for post-LT recurrence); fatal graft rejection was reported in 40.0% (n = 6/15) and mortality in 80.0% (n = 12/15). Conclusion. ICIs are safe and effective against unresectable HCC, but caution is warranted regarding their use in the LT setting because of the high graft rejection rate. The Oncologist 2020;25:1-14 Implications for Practice: This systematic review pooled the outcomes from studies reporting on the use of immune checkpoint inhibitors (ICIs) for the management of 2,402 patients with advanced-stage hepatocellular carcinoma (HCC), 2,376 of whom had unresectable HCC. The objective response rate and disease control rate were 22.7% and 60.7%, respectively, and the mean overall survival was 15.8 months. The overall rate of treatment discontinuation because of adverse events was 14.9%. Fifteen patients received ICIs in the liver transplant (LT) setting (one pre-LT for bridging, 14 for post-LT recurrence). Six of these patients experienced graft rejection (40.0%).

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“…However, the subsequent phase I and phase II clinical investigation [160] and several retrospective studies [15,161,162] have revealed the safety and efficacy of TARE using 90 Y isotope-loaded particles in the treatment of HCC. Specifically, the HCC patients treated with TARE showed similar therapy responses compared to alternative therapies including cTACE, TACE, and chemotherapy (sorafenib) [163][164][165][166]. In general, TARE is becoming a promising treatment option for unresectable primary or secondary liver malignancies [152,167].…”

Section: Microspheres For Radioembolizationmentioning

confidence: 97%

Bench-to-bedside development of multifunctional flexible embolic agents

Wang¹,

Rao²

2023

Theranostics

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Transarterial chemoembolization (TACE) has been demonstrated to provide a survival benefit for patients with unresectable hepatocellular carcinoma (HCC). However, conventional TACE still faces limitations associated with complications, side effects, unsatisfactory tumor responses, repeated treatment, and narrow indications. For further improvement of TACE, additional beneficial functions such as degradability, drug-loading and releasing properties, detectability, targetability, and multiple therapeutic modalities were introduced. The purpose here is to provide a comprehensive overview of current and emerging particulate embolization technology with respect to materials. Therefore, this review systematically identified and described typical features, various functions, and practical applications of recently emerging micro/nano materials as particulate embolic agents for TACE. Besides, new insights into the liquid metals-based multifunctional and flexible embolic agents were highlighted. The current development routes and future outlooks of these micro/nano embolic materials were also presented to promote advancement in the field.

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Highlighting Survival with Yttrium-90 Radioembolization Therapy in Unresectable Hepatocellular Carcinoma

Cited by 4 publications

References 19 publications

Review of outcomes of combination therapy using yttrium 90 radioembolization and sorafenib/nivolumab for HCC with hepatic vein or IVC invasion

Review of outcomes of combination therapy using yttrium 90 radioembolization and sorafenib/nivolumab for HCC with hepatic vein or IVC invasion

The Role of Immunotherapy in Hepatocellular Carcinoma: A Systematic Review and Pooled Analysis of 2,402 Patients

Bench-to-bedside development of multifunctional flexible embolic agents

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