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Addition of Y-90 radioembolization increases tumor response and local disease control in hepatocellular carcinoma patients receiving sorafenib
European Journal of Nuclear Medicine and Molecular Imaging ( IF 9.1 ) Pub Date : 2022-08-02 , DOI: 10.1007/s00259-022-05920-8
Osman Öcal 1 , Kerstin Schütte 2, 3 , Christoph J Zech 4 , Christian Loewe 5 , Otto van Delden 6 , Vincent Vandecaveye 7 , Chris Verslype 8 , Bernhard Gebauer 9 , Christian Sengel 10 , Irene Bargellini 11 , Roberto Iezzi 12 , Alexander Philipp 13 , Thomas Berg 14 , Heinz J Klümpen 15 , Julia Benckert 16 , Maciej Pech 17 , Antonio Gasbarrini 18 , Holger Amthauer 19 , Peter Bartenstein 20 , Bruno Sangro 21 , Peter Malfertheiner 13 , Jens Ricke 1 , Max Seidensticker 1
Affiliation  

Purpose

To compare the treatment response and progression-free survival (PFS) in advanced hepatocellular carcinoma (HCC) patients who received sorafenib treatment either alone or combined with radioembolization (RE).

Methods

Follow-up images of the patients treated within a multicenter phase II trial (SORAMIC) were assessed by mRECIST. A total of 177 patients (73 combination arm [RE + sorafenib] and 104 sorafenib arm) were included in this post-hoc analysis. Response and progression characteristics were compared between treatment arms. Survival analyses were done to compare PFS and post-progression survival between treatment arms. Multivariate Cox regression analysis was used to compare survival with factors known to influence PFS in patients with HCC.

Results

The combination arm had significantly higher objective response rate (61.6% vs. 29.8%, p < 0.001), complete response rate (13.7% vs. 3.8%, p = 0.022), and a trend for higher disease control rate (79.2% vs. 72.1%, p = 0.075). Progression was encountered in 116 (65.5%) patients and was more common in the sorafenib arm (75% vs. 52.0%, p = 0.001). PFS (median 8.9 vs. 5.4 months, p = 0.022) and hepatic PFS were significantly better in the combination arm (9.0 vs. 5.7 months, p = 0.014). Multivariate analysis confirmed the treatment arm as an independent predictor of PFS.

Conclusion

In advanced HCC patients receiving sorafenib, combination with RE has an additive anticancer effect on sorafenib treatment resulting in a higher and longer tumor response. However, the enhanced response did not translate into prolonged survival. Better patient selection and superselective treatment could improve outcomes after combination therapy.



中文翻译:

加入 Y-90 放射栓塞可提高接受索拉非尼治疗的肝细胞癌患者的肿瘤反应和局部疾病控制

目的

比较单独接受索拉非尼治疗或联合放射栓塞治疗 (RE) 的晚期肝细胞癌 (HCC) 患者的治疗反应和无进展生存期 (PFS)。

方法

在多中心 II 期试验 (SORAMIC) 中接受治疗的患者的随访图像由 mRECIST 进行评估。共有 177 名患者(73 名联合组 [RE + 索拉非尼] 和 104 名索拉非尼组)被纳入该事后分析。比较治疗组之间的反应和进展特征。进行生存分析以比较治疗组之间的 PFS 和进展后生存。多变量 Cox 回归分析用于比较生存与已知影响 HCC 患者 PFS 的因素。

结果

联合治疗组具有显着更高的客观缓解率(61.6% 对 29.8%,p  < 0.001)、完全缓解率(13.7% 对 3.8%,p  = 0.022)和更高的疾病控制率趋势(79.2% 对. 72.1%,p  = 0.075)。116 名 (65.5%) 患者出现疾病进展,索拉非尼组更​​为常见(75% 对 52.0%,p  = 0.001)。联合治疗组的PFS(中位数 8.9 与 5.4 个月,p  = 0.022)和肝脏 PFS 明显更好(9.0 与 5.7 个月,p  = 0.014)。多变量分析证实治疗组是 PFS 的独立预测因子。

结论

在接受索拉非尼治疗的晚期 HCC 患者中,与 RE 联合使用对索拉非尼治疗具有附加抗癌作用,从而导致更高和更长的肿瘤反应。然而,增强的反应并没有转化为延长的生存期。更好的患者选择和超选择性治疗可以改善联合治疗后的结果。

更新日期:2022-08-02
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