Yttrium‐90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Study

Salem, Riad; Johnson, Guy E.; Kim, Edward; Riaz, Ahsun; Bishay, V.; Boucher, Éveline; Fowers, Kirk D.; Lewandowski, Robert J.; Padia, Siddharth A.

doi:10.1002/hep.31819

Cited by 268 publications

(248 citation statements)

References 34 publications

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“…Most recently, a multicenter, single-arm, retrospective study conducted at three separate medical centers called the LEGACY study assessed the clinical efficacy of TARE therapy in unrespectable HCC [67]. Chemoembolization served as a primary treatment for 72.2% of the cohort with advanced disease.…”

Section: Y-90 Trans-arterial Radio-embolizationmentioning

confidence: 99%

“…Chemoembolization served as a primary treatment for 72.2% of the cohort with advanced disease. The three-year OS rate for the entire cohort was 86.6% with 62.2% of patients experiencing a duration of response of greater than six months [67]. This study led to the FDA approval of TheraSphere Y-90 Glass Microsphere for treatment of advanced HCC [68].…”

Section: Y-90 Trans-arterial Radio-embolizationmentioning

confidence: 99%

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Treatment of Advanced Hepatocellular Carcinoma

Aryan¹,

Altshuler²,

Qian³

et al. 2022

Hepatocellular Carcinoma - Challenges and Opportunities of a Multidisciplinary Approach

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Hepatocellular Carcinoma (HCC) is the fifth most common cancer and represents the fourth most common cause of cancer related death worldwide. Treatment of HCC is dictated based upon cancer stage, with the most universally accepted staging system being the Barcelona Clinic Liver Cancer (BCLC) staging system. This system takes into account tumor burden, active liver function, and patient performance status. BCLC stage C HCC is deemed advanced disease, which is often characterized by preserved liver function (Child-Pugh A or B) with potential portal invasion, extrahepatic spread, cancer related symptoms, or decreased performance status. Sorafenib has been the standard treatment for advanced HCC over the past decade; however, its use is limited by low response rates, decreased tolerance, and limited survival benefit. Researchers and clinicians have been investigating effective treatment modalities for HCC over the past several years with a focus on systemic regimens, locoregional therapy, and invasive approaches. In this systemic review, we discuss the management of advanced HCC as well as the ongoing research on various treatment opportunities for these patients.

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Section: Y-90 Trans-arterial Radio-embolizationmentioning

confidence: 99%

Section: Y-90 Trans-arterial Radio-embolizationmentioning

confidence: 99%

Treatment of Advanced Hepatocellular Carcinoma

Aryan¹,

Altshuler²,

Qian³

et al. 2022

Hepatocellular Carcinoma - Challenges and Opportunities of a Multidisciplinary Approach

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show abstract

“… 9 TARE with selectively delivered ablative doses of 90 Y containing glass microspheres is an effective therapy for early-stage HCC which has been recently approved by the US Food and Drug Administration. 6 , 18 , 19 Due to gradual parenchymal devitalization over several months, TARE allows for the safe ablation of hepatic volumes equivalent to an anatomic resection without the instantaneous loss of liver function and sinusoidal reserve. While general safety has been established when treating two Couinaud segments or less, a more granular understanding of how much liver can be treated as a function of hepatic substrate has not been established.…”

Section: Discussionmentioning

confidence: 99%

Biochemical Safety of Ablative Yttrium-90 Radioembolization for Hepatocellular Carcinoma as a Function of Percent Liver Treated

Ramos¹,

Overfield²,

Montazeri³

et al. 2021

JHC

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Purpose Transarterial radioembolization can serve as an ablative therapy for early-stage hepatocellular carcinoma (HCC). Given the volumetric variability of liver segments, this study aimed to characterize the safety of ablative radioembolization by determining percent liver treated (%LT) thresholds associated with biochemical toxicity. Patients and Methods Patients with HCC receiving a single ablative radioembolization treatment using glass microspheres from 2017 through 2020 were reviewed. %LT was calculated as treatment angiosome volume divided by whole liver volume. Biochemical toxicities were defined as increases in Albumin-Bilirubin (ALBI) grade or Child-Pugh (CP) class compared to baseline and albumin or bilirubin adverse events (AEs) per the Common Terminology Criteria for Adverse Events. Receiver operating characteristic curves and multivariate logistic regression analyses were performed to assess the impact of %LT on toxicities. Results Of 141 patients analyzed, 53% (n=75) were ALBI 1, 45% (n=64) ALBI 2, 79% (n=111) CP-A, and 21% (n=30) CP-B. A %LT ≥14.5% was associated with grade/class increases in ALBI 2 ( p ≤0.01) and CP-B patients ( p =0.026). In multivariate analysis, a %LT ≥14.5% was an independent predictor of increases in the ALBI 2 and CP-B groups ( p <0.01). No significant %LT threshold was found for ALBI 1 and CP-A patients. No grade 3/4 albumin or bilirubin AEs were reported, while grade 2 AEs were related to an initial whole liver volume <1.3 L ( p ≤0.01). Conclusion Patients with ALBI 2 and CP-B liver function are less likely to have an increase in their respective grade/class when treating <14.5% of the liver using glass microspheres. ALBI 1 and CP-A patients showed no definitive %LT threshold for biochemical toxicity within the range of this study.

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“…[14][15][16] Recently in LEGACY, we successfully demonstrated a prolonged DoR after radioembolization in solitary unresectable HCC, providing clinically meaningful data to the medical oncology and hepatology communities, which valued this metric in its understanding of the effects of immunotherapy. 6 In 2021, DOSISPHERE quantified the value of personalized dosimetry that had been missing from prior RCTs. 17 Improving upon an already efficient outpatient therapy, we have further streamlined care by postulating that the lungshunt fraction estimation in patients with small tumors can be eliminated.…”

Section: Introductionmentioning

confidence: 99%

“…It is very well tolerated with few adverse events and is successfully applied across early, intermediate, and advanced patients within all age groups. 5,6 Guided by two decades of clinical experience and rigorous data collection and analysis, our institution formally adopted 90 Y radioembolization as a primary treatment for HCC in 2018. 7 What follows is the HCC treatment algorithm, used at our institution (an urban, academic, tertiary-care hospital), developed under the guidance of our multidisciplinary…”

mentioning

confidence: 99%

Contemporary Algorithm for the Management of Hepatocellular Carcinoma in 2021: The Northwestern Approach

Swersky

Kulik

Kalyan

et al. 2021

Semin intervent Radiol

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Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major cause of cancer-related morbidity and mortality around the world. Frequently, concurrent liver dysfunction and variations in tumor burden make it difficult to design effective and standardized treatment pathways. Contemporary treatment guidelines designed for an era of personalized medicine should consider these features in a more clinically meaningful way to improve outcomes for patients across the HCC spectrum. Given the heterogeneity of HCC, we propose a detailed clinical algorithm for selecting optimal treatment using an evidence-based and practical approach, incorporating liver function, tumor burden, the extent of disease, and ultimate treatment intent, with the goal of individualizing clinical decision making.

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Yttrium‐90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Study

Cited by 268 publications

References 34 publications

Treatment of Advanced Hepatocellular Carcinoma

Treatment of Advanced Hepatocellular Carcinoma

Biochemical Safety of Ablative Yttrium-90 Radioembolization for Hepatocellular Carcinoma as a Function of Percent Liver Treated

Contemporary Algorithm for the Management of Hepatocellular Carcinoma in 2021: The Northwestern Approach

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