Northwestern 15-Year Experience Informs Institutional Decision to Adopt Y-90 TARE as Primary Treatment for HCC

 

December 26, 2017— Findings from a study of yttrium-90 (Y-90) transarterial radioembolization (TARE) were published by Riad Salem, MD, et al online ahead of print in Hepatology. TARE is a transarterial locoregional therapy for hepatocellular carcinoma (HCC).

The investigators from Northwestern University in Chicago, Illinois, reported overall survival outcomes in a 1,000-patient cohort acquired over a 15-year period, which informed their institutional decision to adopt Y-90 as the primary treatment for HCC. The patients were treated with TARE between December 1, 2003 and March 31, 2017 as part of this prospective cohort study.

As summarized in Hepatology, the investigators performed a comprehensive review of toxicity and survival outcomes. Outcomes were stratified by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Albumin and bilirubin laboratory toxicities were compared to baseline.

Using censoring and intention-to-treat methodologies to determine overall survival outcomes, the investigators found that in CP A patients, censored overall survival for BCLC A was 47.3 months (confidence interval [CI], 39.5–80.3), BCLC B 25 months (CI, 17.3–30.5), and BCLC C 15 months (CI, 13.8–17.7).

In CP B patients, censored overall survival for BCLC A was 27 months (CI, 21–30.2), BCLC B 15 months (CI, 12.3–19), and BCLC C 8 months (CI, 6.8–9.5).

There were 49 (5%) and 110 (11%) patients who developed grade 3/4 albumin and bilirubin toxicities, respectively.

The study's conclusion is that based on this experience with 1,000 patients over 15 years, the investigators at Northwestern decided to adopt TARE as the first-line transarterial locoregional therapy for patients with HCC. This decision was informed by prospective data and incrementally reported demonstrating outcomes stratified by BCLC, applied as either neoadjuvant or definitive treatment, advised the investigators in Hepatology.

 

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