Radioembolization Prior to Checkpoint Inhibitor Immunotherapy versus Radioembolization Post Checkpoint Inhibitor Immunotherapy for the Treatment of Intermediate and Advanced Stage Hepatocellular Carcinoma

Monday, March 6, 2023

3:36 PM – 3:45 PM

Location: Phoenix Convention Center, 224AB

Abstract Speaker(s)

Kartikeya M. Menon, BA (he/him/his)

Medical Student
Icahn School of Medicine at Mount Sinai

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Ricki A. Gottlieb, MD

Resident
Icahn School of Medicine at Mount Sinai
Edward Kim, MD

Professor of Radiology
Mount Sinai Health System
Vivian L. Bishay, MD

IR
Mount Sinai
AF

Aaron M. Fischman, MD, FSIR, FCIRSE, FSVM

Professor, Diagnostic, Molecular and Interventional Radiology
Icahn School of Medicine at Mount Sinai
F Scott Nowakowski, MD

Professor of Radiology and Surgery
Mount Sinai Medical System
RP

Rahul S. Patel, MD

Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Medical Center\n
RP

Rajesh I. Patel, MD

Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Hospital
Dan Shilo, MD

Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Hospital
Robert A. Lookstein, MD

Executive Vice Chair; Diagnostic, Molecular, and Interventional Radiology
Icahn School of Medicine at Mount Sinai
Kirema Garcia-Reyes, MD (she/her/hers)

Assistant Professor
Icahn School of Medicine at Mount Sinai

Disclosure(s):

Kartikeya M. Menon, BA: No financial relationships to disclose

Ricki A. Gottlieb, MD: No financial relationships to disclose

F Scott Nowakowski, MD: No financial relationships to disclose

Robert A. Lookstein, MD: No relevant disclosure to display

Kirema Garcia-Reyes, MD: No financial relationships to disclose

Purpose: This study sought to identify differences in survival, disease progression, objective response rates, and disease control rates in patients who received immune checkpoint inhibitor (ICI) therapy prior to transarterial radioembolization (TARE) compared to those who underwent ICI therapy post TARE for the treatment of moderate and advanced stage hepatocellular carcinoma (HCC).

Materials and Methods:
A retrospective review of patients presented at an institutional multidisciplinary liver tumor board between 1/1/2012 and 6/1/2022 was conducted. Those who underwent TARE within 90 days of initiation of ICI therapy for the treatment of HCC were included in the analysis. Patients who initiated systemic therapy and underwent TARE less than one week apart were excluded. 1:1 (ICI first:TARE first) propensity matching for age, sex, etiology, pre-treatment alpha fetoprotein, Child-Pugh score, BCLC stage, presence of vascular invasion, presence of extrahepatic metastasis, and variables for timing of treatments was conducted. Kaplan-Meier analysis compared median overall survival, progression-free survival, and univariate statistics identified differences in disease response and control rates.

Results: A total of 47 patients who received both TARE and ICI were analyzed, including 19 who started ICI therapy prior to TARE and 28 who underwent TARE before starting ICI therapy. Propensity matching produced no significant differences in nearly all baseline characteristics, though age remained different between the cohorts (ICI first: 61.3 ± 9.2 years, TARE first: 68.3 ± 6.4 years). Patients receiving ICI therapy followed by TARE had better median progression-free survival (13.3 months vs 5.3 months, p < 0.005), objective response rates by mRECIST (68.4% vs 21.1%, p = 0.003), and disease control rates by mRECIST (68.4% vs 31.5%, p = 0.02). Median survival between the groups was not statistically significant.

Conclusion: This retrospective, single-center analysis of propensity matched patients receiving combination therapy with ICI and TARE found that patients who received ICI immunotherapy prior to TARE had significantly better objective response rates and disease control rates by mRECIST, along with better progression-free survival compared to those who received TARE first.