Disease control and failure patterns of unresectable hepatocellular carcinoma following transarterial radioembolization with yttrium-90 microspheres and with/without sorafenib

ARTICLE HIGHLIGHTS

Research background

Survival outcome of unresectable hepatocellular carcinoma (HCC) patients post yttrium-90 (Y-90) glass microspheres transarterial radioembolization (TARE) with/without sorafenib according to individual’s disease burden might partly be confounded by subsequent treatments. Therefore, a study on tumor response might better represent effectiveness of TARE with/without sorafenib.

Research motivation

Disease control and failure patterns following TARE with/without sorafenib might suggest how to intensify treatment to improve treatment outcome.

Research objectives

This study describes the disease control and failure patterns of unresectable HCC patients who underwent Y-90 microspheres TARE with/without sorafenib according to individuals’ disease burden, i.e., intrahepatic tumor (IHT) and adverse disease features (ADFs), consisting of macrovascular invasion, extrahepatic disease (EHD) and infiltrative/ill-defined HCC.

Research methods

Y-90 microspheres TARE procedures with available pre and post-treatment imaging studies (n = 169) were retrospectively reviewed and categorized into 3 subgroups on the basis of treatment given and individuals’ disease conditions: (1) TARE_alone, referred to TARE only for IHT ≤ 50% without ADFs (n = 63); (2) TARE_sorafenib, referred to TARE with sorafenib for IHT > 50% and/or presence of ADFs (n = 81); and (3) TARE_no_sorafenib, referred to TARE only for patients with contraindication to sorafenib or side effect intolerance (n = 25). Disease control rate (DCR; consisted of complete response, partial response and stable disease) and failure patterns of treated, intrahepatic and extrahepatic sites were assessed using mRECIST.

Research results

The key findings were that TARE_alone for procedures with IHT ≤ 50% and absence of ADFs and TARE_sorafenib for procedures with IHT > 50% and/or presence of ADFs could provide comparable DCR (79% vs 72%) with similar incidence of intrahepatic progression (44.5% vs 38.5%). However, extrahepatic progression was much more common in TARE_sorafenib procedures (13% vs 32%).

Research conclusions

DCR of TARE_alone and TARE_sorafenib procedures were similar (about 70%). Intrahepatic progression was dominant failure pattern for both (about 40%) but extrahepatic progression was far more common in TARE_sorafenib procedures.

Research perspectives

On the basis of findings in the present study, we suggested further investigations on additional treatment to enhance disease control. Disease progression in TARE_alone subgroup usually originated in treated area and mostly limited to intrahepatic area. Thus, local or systemic treatment which potentiates disease control at treated lesion might result in better overall disease control. In TARE_sorafenib subgroup, extrahepatic progression was common and pre-existing EHD could worsen disease control. Study on novel systemic therapy that is more potent than sorafenib might be required to improve treatment outcome in this group of patients.