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Improved Tumor Response in Patients on Metformin Undergoing Yttrium-90 Radioembolization Segmentectomy for Hepatocellular Carcinoma

  • Clinical Investigation
  • Interventional Oncology
  • Published:
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Abstract

Purpose

Metformin is associated with improved outcomes after external radiation and chemotherapy but has not been studied for Y-90 radiation segmentectomy (RS). This study evaluates the effect of metformin on tumor response after Y-90 RS in patients with hepatocellular carcinoma (HCC).

Methods and Materials

A retrospective analysis of patients with HCC who underwent Y-90 RS between 2014–2018 was performed. Comparisons were made between all patients taking and not taking metformin, and diabetic patients taking and not taking metformin. Tumor response was analyzed with logistic regression to compare absolute and percent change in total tumor diameter (TTD) and modified Response Evaluation Criteria in Solid Tumors (mRECIST). Overall survival (OS) was evaluated using Kaplan–Meier estimation and log-rank analysis.

Results

A total of 106 patients underwent 112 Y-90 RS, of which 40 were diabetic (38.8%) and 19 (18.4%) were on metformin. At baseline, the two groups of patients on metformin and not on metformin had no significant difference in age, Child–Pugh score, MELD score, ALBI grade, total tumor diameter, and size of dominant tumor. The only significant baseline difference was ECOG status. Uni- and multivariate analysis demonstrated a larger reduction in TTD and objective response by mRECIST criteria for patients undergoing Y-90 RS on metformin compared to those not on metformin. OS was similar between patients taking and not taking metformin (p = 0.912).

Conclusion

Metformin may be associated with increased tumor response after Y-90 RS in patients with HCC.

Level of Evidence

III, Retrospective Study.

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Authors and Affiliations

  1. Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Mohammad Elsayed, William Wagstaff, Keywan Behbahani, Alexander Villalobos, Zachary Bercu, Bill S. Majdalany & Nima Kokabi

  2. Department of Hematology and Medical Oncology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Mehmet Akce

  3. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    David M. Schuster

  4. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Hui Mao

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  1. Mohammad Elsayed
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Contributions

Mohammad Elsayed conceived the analysis, contributed the data, performed the analysis, and wrote the paper. William Wagstaff contributed the data and performed the analysis. Keywan Behbahani wrote the paper. Alexander Villalobos contributed the data and performed the analysis. Zachary Bercu contributed data. Bill Majdalany contributed the data. Mehmet Akce contributed the data. David Schuster contributed the data. David M Schuster contributed the data. Hui Mao contributed the data and performed the analysis. Nima Kokabi conceived the analysis, contributed the data, performed the analysis, and wrote the paper.

Corresponding author

Correspondence to Mohammad Elsayed.

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Conflict of interest

The senior author, Nima Kokabi MD, conducts Y-90 radioembolization research partially funded by Sirtex Medical Ltd. Richard Duszak, Jr., MD receives research support from the Harvey L. Neiman Health Policy Institute.

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Elsayed, M., Wagstaff, W., Behbahani, K. et al. Improved Tumor Response in Patients on Metformin Undergoing Yttrium-90 Radioembolization Segmentectomy for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 44, 1937–1944 (2021). https://doi.org/10.1007/s00270-021-02916-z

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