EASL 2009: Radioembolization With Yttrium-90 May Be Safe and Effective in Advanced Liver Cancer

Becky McCall

May 03, 2009

May 3, 2009 (Copenhagen, Denmark) — A phase 2 study of radioembolization with yttrium-90 has shown it to be effective and safe for the treatment of advanced hepatocellular carcinoma (HCC), with or without portal vein thrombosis. The study was presented here at the European Association for the Study of the Liver (EASL) 44th Annual Meeting.

Advanced HCC is particularly difficult to treat, leaving clinicians with few therapeutic options. Guido Gerken, MD, a hepatologist from the University of Essen, Germany, explained that only patients with good liver function and early HCC are candidates for liver resection or transplantation, but because most patients have advanced liver disease at diagnosis, they are unsuitable candidates for surgery.

"These patients may have locoregional treatment such as ablation and chemoembolization. Failing this, the next option might be consideration for sorafinib, a new drug with antiproliferative effects. Unfortunately, ablation and chemoembolization have a high rate of recurrence at follow-up, so in our study we explored a further option for advanced tumours, radioembolization," Dr. Gerken explained to Medscape Gastroenterology.

HCC is the third most common cause of cancer-related death in the world and in 85% of cases it develops in patients with complete liver cirrhosis, which is the most common risk factor for this type of cancer. Radioembolization is a new form of brachytherapy for liver tumors that consists of delivering millions of radioactive implants into the arteries that feed the tumors. This provides a high dose of radiation to tumor nodules while preserving the noncancerous liver tissue from a harmful level of radiation.

In this study, 70 patients with advanced primary HCC, with and without portal vein invasion, received radioembolization using glass microspheres labelled with radioactive yttrium-90. "After injection into the right or left liver artery, the radioactive microspheres are concentrated in the tumor capillary bed with a high dose of local directed radiation," explained Dr. Gerken.

Progression-free survival after 6.5 months of follow-up was 78%. The estimated Kaplan-Meier 1-year survival rate was 72%. Dr. Gerken explained that partial radiological response rate was achieved in 52% and 80% according to RECIST and EASL criteria, respectively. "In our study, radioembolization with yttrium-90 glass microspheres (TheraSpheres) is a safe and effective treatment for patients with advanced HCC, with or without portal vein thrombosis. Statistically, time to progression in this study is comparable to systemic therapy," Dr. Gerken said.

Tim Greten, MD, from the Hannover Medical School in Germany, said the results are promising, especially in patients with few other treatment options. "SIRT, or selective internal radiation therapy, is not a standard treatment for patients with HCC yet, and there are only a limited number of centers worldwide offering this type of therapy. However, a number of studies have shown promising results using this new technology.

"Unfortunately, at present there is no data from phase 3 trials available, but the study by Gerken and colleagues suggests that SIRT can be safely done in patients with advanced HCC. This type of treatment is an important new step in the treatment of this form of cancer," Dr. Greten told Medscape Gastroenterology.

Large, prospective multicenter clinical trials including combination trials between locoregional strategies and systemic therapies will be the next step for this therapy. "Yttrium-90 radioembolization combination treatment with sorafinib needs to be assessed to improve the survival rate and the outcome of patients with primary liver carcinoma," Dr. Greten concluded.

Dr. Gerken and Dr. Greten have disclosed no relevant financial relationships.

European Association for the Study of the Liver (EASL) 44th Annual Meeting: Abstract 51. Presented April 24, 2009.

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