SIR 2024
Interventional Oncology
Ava Zamani, BA
Medical Student
Univeristy of Queensland-Ochsner Clinical School
Financial relationships: Full list of relationships is listed on the CME information page.
Kelley Nunez, PhD
Disclosure information not submitted.
Tyler Sandow, MD
Interventional Radiologist
Ochsner Health
Financial relationships: Full list of relationships is listed on the CME information page.
Ari Cohen, MD
Medical Director of Multi-Organ Transplant Institute
Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, 70121
Disclosure information not submitted.
Paul Thevenot, PhD
Associate Professor
Ochsner Clinic Foundation
Disclosure information not submitted.
90Yittrium (90Y) radioembolization has emerged as a secondary treatment option for early- to intermediate-stage hepatocellular carcinoma (HCC) in the Barcelona Clinic Liver Cancer (BCLC) Staging and Treatment Algorithm. The LEGACY, TARGET, and RASER trials have recently shown that 90Y is a safe and effective primary treatment option for BCLC A-B. In this study, the outcomes for 3 treatment centers within a single health system with experience utilizing 90Y as a definitive treatment option for BCLC A-B are analyzed in the context of the reported trial results.
Materials and Methods:
Single system, multi-center study of 90Y was utilized as the primary option for treatment naïve, non-resectable, HCC within BCLC A-B with ECOG 0-1 and Child-Pugh (CP) A5 – B9 (n = 219, 2016 - 2023). First cycle objective response (OR) rate, target time to retreatment (tTTR), target duration of response (tDOR), and time to BCLC-C progression (TTP) were analyzed and compared to the results of the LEGACY (solitary ≤ 8cm, CP-A, ECOG 0-1, target > 400Gy to tumor), TARGET (≥ 3cm, up to CP-B7, BCLC A-C), and RASER (≤ 3cm, up to CP-B9, ECOG 0) trials.
Results:
The overall first-cycle OR rate was 74% (150/204). Median tTTR was 12-months (95% CI 10 – 31 months) with 89% having a tDOR at 12-months. The 12-month rate of progression to BCLC-C was 23%. In patients matching LEGACY trial inclusion criteria (n = 61), median tTTR increased to 17-months with a 79% first-cycle OR rate and 24% progression risk at 24-months. In patients matching TARGET trial criteria (n = 121), first cycle OR was 70% (80/115 available) compared to 62% in the TARGET study (n = 209). With RASER study criteria (n = 64), the overall first cycle OR was 81% (48/59 available) with 97% of patients having a tDOR at 24-months.
Conclusion:
These results from a regional health system reproduce the findings of the LEGACY, TARGET, and RASER trials, utilizing 90Y as the primary approach of liver-directed therapy in early- to intermediate-stage HCC.