Increased Quality of Life Among Hepatocellular Carcinoma Patients Treated With Radioembolization, Compared With Chemoembolization

Salem, Riad; Gilbertsen, Margaret; Butt, Zeeshan; Memon, Khairuddin; Vouche, Michaël; Hickey, Ryan; Baker, Talia; Abécassis, Michaël; Atassi, Rohi; Riaz, Ahsun; Cella, David; Burns, James; Ganger, Daniel; Benson, Al B.; Mulcahy, Mary F.; Kulik, Laura; Lewandowski, Robert J.

doi:10.1016/j.cgh.2013.04.028

Cited by 213 publications

(125 citation statements)

References 28 publications

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“…A randomized controlled trial showed a benefit progression free survival of TARE (Y90) in patient with liver metastasis to colorectal tumors, after which, TARE (Y90) has been approved by the FDA (34). Presently, the safety and effectiveness of TARE (Y90) in advanced HCCs especially associated with portal vein thrombosis have been partly affirmed by many studies (11,(35)(36)(37). Therefore, it is necessary to compare the efficacy and safety of TARE with Y90 in patients with intermediate or advanced stage HCCs.…”

Section: Discussionmentioning

confidence: 98%

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

Zhang

et al. 2015

BST

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Section: Discussionmentioning

confidence: 98%

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

Zhang

et al. 2015

BST

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“…Radioembolization is an emerging and effective treatment for hepatic mNETs, with a superior toxicity profile (10)(11)(12). Multiple studies in the published literature have described outcomes of radioembolization for these patients.…”

Section: Discussionmentioning

confidence: 99%

“…90 Y resin radioembolization has been shown to be an effective treatment for hepatic mNETs that is well tolerated, with low risk of grade 3 or higher early or late toxicity, and a superior quality of life profile (10)(11)(12). It involves injecting arteriole 30-mm-sized embolic resin (SIR-Spheres; Sirtex Medical Ltd.) or glass (TheraSphere; BTG Inc.) microspheres loaded with the b-emitting radioisotope 90 Y into the tumor hepatic arterial supply.…”

mentioning

confidence: 99%

The Efficacy of Hepatic ⁹⁰Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis

et al. 2014

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90 Y resin radioembolization is an emerging treatment in patients with liver-dominant metastatic neuroendocrine tumors (mNETs), despite the absence of level I data. The aim of this study was to evaluate the efficacy of this modality in a meta-analysis of the published literature. Methods: A comprehensive review protocol screened all reports in the literature. Strict selection criteria were applied to ensure consistency among the selected studies: human subjects, complete response data with time interval, resin microspheres, more than 5 patients, not a duplicate cohort, English language, and separate and complete data for resin-based 90 Y treatment of mNET if the study included multiple tumor and microsphere types. Selected studies were critically appraised on 50 study criteria, in accordance with the research reporting standards for radioembolization. Response data (Response Evaluation Criteria in Solid Tumors) were extracted and analyzed using both fixed and random-effects meta-analyses. Results: One hundred fifty-six studies were screened; 12 were selected, totaling 435 procedures for response assessment. Funnel plots showed no evidence of publication bias (P 5 0.841). Critical appraisal revealed a median of 75% of desired criteria included in selected studies. Very high between-study heterogeneity ruled out a fixed-effects model. The random-effects weighted average objective response rate (complete and partial responses, CR and PR, respectively) was 50% (95% confidence interval, 38%-62%), and weighted average disease control rate (CR, PR, and stable disease) was 86% (95% confidence interval, 78%-92%). The percentage of patients with pancreatic mNET was marginally associated with poorer response (P 5 0.030), accounting for approximately 23% of the heterogeneity among studies. The percentage of CR and PR correlated with median survival (R 5 0.85; P 5 0.008). Conclusion: This meta-analysis confirms radioembolization to be an effective treatment option for patients with hepatic mNET. The pooled data demonstrated a high response rate and improved survival for patients responding to therapy.

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“…Although no survival benefit over TACE has yet to be demonstrated, radioembolization has been shown to provide secondary benefits over TACE including decreased toxicity (44) and improved quality-of-life regarding diarrhea, fever, chills adverse effects and anorexia (53). Furthermore, radioembolization can be performed on an outpatient basis.…”

Section: Discussionmentioning

confidence: 99%

Locoregional and systemic therapy for hepatocellular carcinoma

Gbolahan

Schacht

Beckley

et al. 2017

J. Gastrointest. Oncol.

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The management of hepatocellular carcinoma (HCC) remains challenging due to late presentation and the presence of accompanying liver dysfunction. As such, most patients are not eligible for curative resection and liver transplant. Management in this scenario depends on a number of factors including hepatic function, tumor burden, patency of hepatic vasculature and patients' functional status. Based on these, patients can be offered catheter based intra-arterial therapy for intermediate stage disease and in more advanced disease, sorafenib. Given recent data, regorafenib is now an option following failure of sorafenib.Catheter directed intra-arterial therapy takes advantage of tumor hypervascularity and the unique dual blood supply of the liver, as hepatic tumors receive arterial perfusion via the hepatic artery while the rest of the liver is supplied by the portal vein. This allows selective embolization and delivery of chemotherapeutic agents to the tumor. Compared to best supportive care, intra-arterial therapy offers a survival benefit in intermediate stage HCC and is the recommended approach for treatment. None of the catheter based approaches; including bland embolization, conventional trans-arterial chemoembolization (cTACE), drug eluting bead trans-arterial chemoembolization (DEB-TACE) or trans-arterial radioembolization (TARE) offers a clear advantage over the other, although DEB-TACE may be characterized by less systemic toxicity. All of these approaches are contraindicated in patients with portal vein thrombosis (PVT). On the other hand, intraarterial, radio embolization, with Yttrium-90 (Y90) can be offered to patients with PVT. The place of this modality in management of HCC is still being investigated. The role of sorafenib in advanced HCC is not in doubt, as until recently, it was the only systemic therapy approved for the management in this setting. This is despite multiple trials evaluating other agents. The addition of sorafenib to catheter-based therapy in intermediate stage disease has also failed to show any benefit. The modest survival benefit with sorafenib and the failure of other targeted agents suggest that it is important to look beyond inhibition of angiogenesis in advanced HCC. Identification of key drivers and mediators of HCC remains paramount for successful drug development. In line with this, it is refreshing that the excitement that has followed developments in cancer immunotherapy is finding its way to HCC with early trials of anti-PD1 monoclonal antibodies showing sufficient activity that phase III trials are now ongoing for Pembrolizumab and Nivolumab in advanced HCC. Future drug development efforts will focus on defining the feasibility of combining different treatment approaches targeting multiple important modulators of HCC.

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Increased Quality of Life Among Hepatocellular Carcinoma Patients Treated With Radioembolization, Compared With Chemoembolization

Cited by 213 publications

References 28 publications

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

The Efficacy of Hepatic ⁹⁰Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis

Locoregional and systemic therapy for hepatocellular carcinoma

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Increased Quality of Life Among Hepatocellular Carcinoma Patients Treated With Radioembolization, Compared With Chemoembolization

Cited by 213 publications

References 28 publications

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

Transarterial Y90 radioembolization versus chemoembolization for patients with hepatocellular carcinoma: A meta-analysis

The Efficacy of Hepatic 90Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis

Locoregional and systemic therapy for hepatocellular carcinoma

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The Efficacy of Hepatic ⁹⁰Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis