Radiotherapy no better than sorafenib for inoperable liver cancer

Last Updated: 2017-11-10

By David Douglas

NEW YORK (Reuters Health) - Selective internal radiotherapy (SIRT) with yttrium-90 resin microspheres does not prolong survival compared to sorafenib in patients with advanced hepatocellular carcinoma not eligible for curative treatment, according to French researchers.

But lead author Dr. Valerie Vilgrain of Hopital Beaujon, in Clichy told Reuters Health by email, "We did observe a better tolerance a better quality of life and a higher tumor control."

The study, an open-label phase 3 trial conducted at 25 centers specializing in liver diseases, was published online October 26 in The Lancet Oncology. Participants had to be at least 18 years old and have a life expectancy greater than three months.

In all, 467 patients were randomly assigned to receive continuous oral sorafenib (400 mg twice daily) or SIRT with yttrium-90-loaded resin microspheres two to five weeks after randomization. Median follow-up was about 28 months.

In the intention-to-treat population, median overall survival with sorafenib (9.9 months) was not significantly greater than the 8.0 months seen with SIRT (P=0.18). In per-protocol analysis, OS was 9.9 months in both groups.

Despite the lack of survival advantage, say the researchers, "tolerability was significantly better in the SIRT group than in the sorafenib group. The total and median numbers of treatment-related adverse events per patient were twice as frequent with sorafenib than with SIRT."

Treatment-related adverse events of grade 3 or higher were also more frequent in the sorafenib group.

Although there was no survival advantage, the team notes, "Quality of life and tolerance might help when choosing between the two treatments." And in light of the apparently greater local efficacy of SIRT, Dr. Vilgrain told Reuters Health by email that the approach "should be also evaluated in a large scale in patients with less advanced disease."

Dr. Ahmed Omar Kaseb, author of an accompanying editorial, told Reuters Health by email, "Controlling local tumors in hepatocellular carcinoma is expected to delay liver failure and ultimately improve quality of life and prolong survival. However, the limitations of the study did not allow for a definite conclusion."

Dr. Kaseb, of the University of Texas MD Anderson Cancer Center, in Houston, added, "In this era of ever-expanding systemic therapy options for HCC and the recent approval of immunotherapy as well (nivolumab), future studies combining yttrium-90 and systemic therapy may show the value of this combination in improving HCC outcome."

The study was funded by Sirtex Medical Inc., manufacturer of the yttrium spheres. Dr. Vilgrain and two other authors have relationships with the company.

SOURCES: http://bit.ly/2zNoS8y and http://bit.ly/2hoUauS

Lancet Oncol 2017.