The Pattern of Progression Defines Post-progression Survival in Patients with Hepatocellular Carcinoma Treated with SIRT

Torre-Aláez, Manuel de la; Jordán-Iborra, Carlota; Casadei-Gardini, Andrea; Bilbao, José Ignacio; Rodríguez‐Fraile, Macarena; Sancho, Lidia; D’Avola, Delia; Herrero, J.I.; Iñarrairaegui, Mercedes; Sangro, Bruno

doi:10.1007/s00270-020-02444-2

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…Prospective studies have demonstrated that prognosis after progression due to increased growth of known tumour sites or new intrahepatic sites is significantly better than progression due to new extrahepatic involvement or vascular invasion [122]. This primed the proposal of a BCLC prognostic model upon progression that is depicted in Figure 2 The prognostic stratification offered by the classification of patients according to their pattern of progression has been repeatedly validated [123][124][125][126]. While pattern of progression is not a predictor of treatment benefit, it has become a relevant parameter to inform patients and to design and analyse clinical trials where a sound survival assumption of the patients recruited is key to establish the potential impact of new agents in life expectancy [114].…”

Section: Evolutionary Events and Clinical-decision Making Process Bclc Staging Upon Progression After Initial Diagnosismentioning

confidence: 99%

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

Reig

Forner

Rimola

et al. 2022

Journal of Hepatology

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2,091

1,796

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Section: Evolutionary Events and Clinical-decision Making Process Bclc Staging Upon Progression After Initial Diagnosismentioning

confidence: 99%

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

Reig

Forner

Rimola

et al. 2022

Journal of Hepatology

Self Cite

2,091

1,796

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“…The pattern of progression to sorafenib impacts prognosis, with new vascular invasion or new extrahepatic lesions being correlated to the worst prognosis [11]. More recently, this has been confirmed for patients treated with ramucirumab [48], and even for locoregional therapies [49]. Although we still lack information about the influence of the pattern of progression on survival after progression to atezo-bev, it seems judicious to extrapolate from all these experiences.…”

Section: When To Switch To Second or Further Line Therapiesmentioning

confidence: 99%

Systemic treatment of hepatocellular carcinoma: An EASL position paper

Bruix

Chan

Galle

et al. 2021

Journal of Hepatology

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263

198

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…6 Phase 3 clinical trials have not shown improved survival when SIRT alone 7 8 or in combination with sorafenib 9 were compared with sorafenib alone. The most common pattern of progression after SIRT is the onset of new tumor lesions inside or outside the liver, 10 an event that carries a poor prognosis. Therefore, the combination of SIRT with an effective, well-tolerated systemic therapy could result in improved efficacy and preserved quality of life.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Nivolumab after selective internal radiation therapy for the treatment of hepatocellular carcinoma: a phase 2, single-arm study

Torre-Aláez

Matilla

Varela

et al. 2022

J Immunother Cancer

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PurposeTo evaluate the safety and efficacy of selective internal radiation therapy (SIRT) in combination with a PD-1 inhibitor in patients with unresectable hepatocellular carcinoma (uHCC) and liver-only disease ineligible for chemoembolization.Patients and methodsNASIR-HCC is a single-arm, multicenter, open-label, phase 2 trial that recruited from 2017 to 2019 patients who were naïve to immunotherapy and had tumors in the BCLC B2 substage (single or multiple tumors beyond the up-to-7 rule), or unilobar tumors with segmental or lobar portal vein invasion (PVI); no extrahepatic spread; and preserved liver function. Patients received SIRT followed 3 weeks later by nivolumab (240 mg every 2 weeks) for up to 24 doses or until disease progression or unacceptable toxicity. Safety was the primary endpoint. Secondary objectives included objective response rate (ORR), time to progression (TTP), and overall survival (OS).Results42 patients received SIRT (31 BCLC-B2, 11 with PVI) and were followed for a median of 22.2 months. 27 patients discontinued and 1 never received Nivolumab. 41 patients had any-grade adverse events (AE) and 21 had serious AEs (SAE). Treatment-related AEs and SAEs grade 3–4 occurred in 8 and 5 patients, respectively. Using RECIST 1.1 criteria, ORR reported by investigators was 41.5% (95% CI 26.3% to 57.9%). Four patients were downstaged to partial hepatectomy. Median TTP was 8.8 months (95% CI 7.0 to 10.5) and median OS was 20.9 months (95% CI 17.7 to 24.1).ConclusionsThe combination of SIRT and nivolumab has shown an acceptable safety profile and signs of antitumor activity in the treatment of patients with uHCC that were fit for SIRT.Trial registration numberNCT03380130

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The Pattern of Progression Defines Post-progression Survival in Patients with Hepatocellular Carcinoma Treated with SIRT

Cited by 9 publications

References 31 publications

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

Systemic treatment of hepatocellular carcinoma: An EASL position paper

Nivolumab after selective internal radiation therapy for the treatment of hepatocellular carcinoma: a phase 2, single-arm study

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