Selective Internal Radiation Therapy Combined with Immune Checkpoint Inhibitors in the treatment of Hepatocellular Carcinoma: A Systematic Review and Single-Arm Meta-Analysis

Monday, March 31, 2025

4:21 PM – 4:30 PM CT

Location: Music City Center, 208 AB

Presenting Author(s)

Miriana Mariussi, MD (she/her/hers)

Clinical Research Fellow
Hospital Israelita Albert Einstein, Brazil

Author/Co-author(s)

LC

Laura Costa de Oliveira Lima, None

Medical Student
Pontifícia Universidade Católica de Campinas (PUCC), Brazil
MG

Mariano Gallo Ruelas, None

Methodologist
Instituto de Investigación Nutricional, Peru
MJ

Marcela Juliano Silva Cunha, MD

Attending Physician
Hospital Israelita Albert Einstein, Brazil
LG

Leonardo Guedes Moreira Valle, MD

Attending Physician
Hospital Israelita Albert Einstein, Brazil
BB

Breno Boueri Affonso, MD

Attending Physician
Hospital Israelita Albert Einstein, Brazil
FL

Francisco Leonardo Galastri, MD

Attending Physician
Hospital Israelita Albert Einstein, Brazil
Felipe Nasser, PhD

IR Hospital Israelita Albert Einstein / Supervisor of the Vascular and Endovascular surgery department Hospital Santa Marcelina
Hospital Israelita Albert Einstein, Brazil
RG

Rodrigo Gobbo Garcia, MD, PhD

Chief of the Division of Interventional Radiology
Hospital Israelita Albert Einstein, Brazil

Purpose: The aim of this systematic review and meta-analysis is to determine the efficacy and safety of selective internal radiation therapy (SIRT) using yttrium-90 (Y-90) combined with immune checkpoint inhibitors (ICIs) in the treatment of hepatocellular carcinoma (HCC).

Materials and Methods: We systematically searched Embase, Cochrane Central Register of Controlled Trials, Pubmed/Medline, and Web of Science from inception to September 10th of 2024 for studies published with the following medical subject heading terms: “selective internal radiation therapy”, “immunotherapy”, “immune checkpoint inhibitors”, and “hepatocellular carcinoma”. In addition, the references of included studies and systematic reviews were evaluated for additional studies. The outcomes of interest were median overall survival (mOS), median progression-free survival (mPFS), median time to tumor progression (mTTP), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs).

Results: The review included seven studies, consisting of four clinical trials and three retrospective cohort studies, with a total of 184 patients. The pooled analysis demonstrated an ORR of 58.08% (95% CI: 39.07 - 77.09) and a DCR of 85.03% (95% CI: 76.23 - 93.83). The pooled mTTP, mPFS and mOS resulted in 7.17 months (95% CI: 5.05 - 9.29), 7.12 months (95% CI: 5.29 - 8.95) and 20.43 months (95% IC: 17.58 - 23.29), respectively. During treatment 53.48% (95% CI: 25.89 - 80.06) of the patients experienced grade 1-2 adverse events, and 16.17% (95% CI: 6.52 - 28.52) experienced grade 3-4 adverse events. One patient in the analysis experienced a grade 5 adverse event.

Conclusion:
The combination of SIRT using Y-90 with ICIs has been shown to be an effective treatment with an acceptable safety profile for HCC. The findings of this systematic review and meta-analysis indicate that the combination of local and systemic therapies may offer promising survival outcomes, justifying the development of larger multicenter randomized trials to further investigate these results.