Comparison of 90Y Radioembolization Outcomes for Hepatocellular Carcinoma (HCC) in TACE-refractory (T-REF) vs Treatment Naïve (TN) Patients in the RESiN Registry (NCT: 02685631)

Sunday, March 5, 2023

3:45 PM – 3:54 PM

Location: Phoenix Convention Center, 227ABC

Presenting Author(s)

Hannah Hund

Medical Student
Vanderbilt University School of Medicine

Disclosure(s): Sirtex Medical: Research Grant or Support ()

Author/Co-author(s)

LD

Liping Du, Ph.D.

Biostatistician
Biostatistics, Vanderbilt University Medical Center
Lea Matsuoka, M.D.

Attending Physician
Vanderbilt University Medical Center
DS

Daniel Y. Sze, MD, PhD (he/him/his)

Professor, Editor in Chief
Stanford University; Journal of Vascular and Interventional Radiology
Andrew S. Kennedy, M.D.

Attending Physician
Sarah Cannon
KV

Kirubahara Vaheesan, MD

Attending - Interventional Radiology
Saint Louis University School of Medicine
MP

Michael Petroziello, M.D.

Attending Physician
Department of Interventional Radiology, Roswell Park Memorial Institute
JG

Jafar Golzarian, MD

Attending Physician
University of Minnesota
EW

Eric A. Wang, M.D.

Attending Physician
Department of Interventional Radiology, Carolinas Medical Center
RG

Ripal Ghandi, MD, FSVM

Attending Physician
Miami Vascular Specialists
ZC

Zachary S. Collins, M.D.

Attending Physician
Department of Interventional Radiology, University of Kansas
JB

Jayson S. Brower, M.D.

Attending Physician
Department of Interventional Radiology, Providence Sacred Heart
JL

Justin S. Lee, MD

Medical Director
Sarasota Memorial Hospital, Department of Radiology
Daniel B. Brown, M.D.

Attending Physician
Vanderbilt University Medical Center

Disclosure(s):

Hannah Hund: Sirtex Medical: Research Grant or Support ()

Daniel Y. Sze, MD, PhD: Artio Medical: Consultant (Terminated, January 1, 2021); Astra Zeneca: Consultant (Terminated, January 1, 2021); Bayer: Consultant (Terminated, January 1, 2021); BlackSwan Vascular: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); Boston Scientific / Biocompatibles BTG: Consultant (Terminated, January 1, 2021), Contracted Research (Terminated, January 1, 2021); Bristol Myers Squibb: Consultant (Terminated, January 1, 2021); Eisai: Consultant (Terminated, January 1, 2021); FluidX: Consultant (Terminated, January 1, 2021); Guerbet: Consultant (Terminated, January 1, 2021); Koli Medical, Inc.: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); RadiAction Medical: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); Sirtex Medical: Consultant (Terminated, January 1, 2021), Contracted Research (Terminated, January 1, 2021); Terumo: Consultant (Terminated, January 1, 2021); Trisalus Life Sciences: Consultant (Terminated, January 1, 2021), Ownership Interest (Terminated, January 1, 2021); Varian: Consultant (Terminated, January 1, 2021); W. L. Gore: Consultant (Terminated, January 1, 2021)

Jafar Golzarian, MD: No relevant disclosure to display

Purpose: To determine whether T-REF HCC patients undergoing resin ⁹⁰Y following TACE have poorer overall survival (OS), imaging response, and toxicity than TN patients.

Materials and Methods: In this prospective, observational study, 321 HCC patients were T-REF (n=117, 36%) or TN (n=204, 64%). Patients who had prior ablation, surgery, or chemotherapy were excluded. Overall and progression-free survival (OS/PFS) outcomes were measured by follow-up and assessed using Kaplan-Meier analysis. Six-month imaging response was evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Six-month toxicities were reported using Common Terminology Criteria for Adverse Events v5.

Results: Baseline demographics are reported in the TABLE. The T-REF group had more bilobar (p=0.03) and multifocal (< 0.001) disease. The TN group was older (p=0.03), with higher incidence of vascular invasion (p=0.04) and larger index tumor diameter (p=0.001). The sum of tumor diameters was not different between groups (p=0.06). Median delivered 90Y activity was similar for T-REF (1.2 GBq: 95% CI: 1-1.6) and TN (1.2 GBq; 95% CI: 0.9-1.6 GBq). The median OS for T-REF was 19.8 months (95% CI: 15.4-25.2) and was 21.5 months (95% CI: 14.9-29.9) for TN vs (p=0.9). Median PFS for T-REF was 8.4 months (95% CI: 6.2-12.1) and 13.0 months (95% CI: 10.8-17.7) for TN (p=0.006). Six-month imaging was available in 67/117 T-REF and 118/204 TN patients. Partial or complete response was seen in 30/67 (45%) of the T-REF and 68/118 (58%) TN patients (p=0.2). Six-month toxicities were available in 88/117 (75%) T-REF and 167/204 (82%) TN patients. Attributable grade 3 or greater albumin and bilirubin toxicities were present in 5/88 (6%) T-REF vs. 7/167 (4%) TN (p=0.2) and 12/87 (14%) T-REF vs 16/204 (8%) TN (p=0.04) patients.

Conclusion:

OS of T-REF patients is similar to TN, but PFS is shorter with similar imaging response at 6 months. Radioembolization is a reasonable treatment option for TACE refractory HCC.