University Adopts Y-90 as First-Line Therapy for HCC

Northwestern University has adopted yttrium-90 (Y-90) transarterial radioembolization (TARE) as first-line locoregional therapy for patients with hepatocellular carcinoma (HCC). The institution’s decision was based on the results of a prospective study that took place over a period of 15 years.

The prospective cohort study began on December 1, 2003 and ended on March 31, 2017. During that time, 1000 patients with HCC received treatment with TARE, after which toxicity and survival outcomes were comprehensively reviewed. This review included stratification by baseline Child-Pugh (CP) class, United Network for Organ Sharing (UNOS), and Barcelona Clinic Liver Cancer (BCLC) staging systems. Additionally, the researchers compared baseline albumin and bilirubin levels with levels after treatment.

“Our decision was informed by data prospectively collected and incrementally reported demonstrating outcomes as expected by the BCLC algorithm for stages A-D, applied as either neoadjuvant or definitive treatment,” the study’s authors stated.

Results showed that 51% of patients were CP A, 45% were CP B, and 4% were CP C. Regarding BCLC, 26% of patients were BCLC A, 15% were B, 54% were C, and 4% were D. UNOS indicated that 37% of patients were UNOS T1/T2, while 17% were T3, 15% were T4a, 22% were T4b, and 9% were N/M. Censored overall survival in CP A patients was 47.3 months, BCLC B was 25.0 months, and BCLC C was 15.0 months. Patients who were CP B had censored overall survival for BCLC A of 27 months, BCLC B for 15.0 months, and BCLC C for 8.0 months.

The study’s authors stated, “Compared with TACE, our data confirm that outpatient TARE allows for fewer treatments, better quality of life, longer time to progression, and versatile application as neoadjuvant LRT combined with either resection or LT.”

Reference

Salem R, Gabr A, Riaz A, et al. Institutional decision to adopt y90 as primary treatment for HCC informed by a 1,000-patient 15-year experience. Hepatology. 2017 Dec 1. doi: 10.1002/hep.29691. [Epub ahead of print].