yttrium-90 resin microspheres as an adjunct to sorafenib in patients with unresectable hepatocellular carcinoma

Armeen Mahvash,1 Ravi Murthy,1 Bruno C Odisio,1 Kanwal Pratap Raghav,2 Lauren Girard,2 Sheree Cheung,1 Van Nguyen,3 Joe Ensor,4 Sameer Gadani,5 Khaled M Elsayes,6 Reham Abdel-Wahab,1,7 Manal Hassan,1 Ahmed S Shalaby,1 James C Yao,1 Michael J Wallace,1 Ahmed O Kaseb2 1Department of Interventional Radiology, 2Department of Gastrointestinal Medical Oncology, 3Department of Pharmacy, 4Department of Statistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 5Department of Radiology, Saint Louis University Hospital, St Louis, MO, 6Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 7Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt Purpose: The safety and efficacy of the combined use of sorafenib and yttrium-90 resin microspheres (Y90 RMS) to treat advanced hepatocellular carcinoma (HCC) is not well established. We determined the incidence of adverse events with this combination therapy in patients with advanced HCC at our institution and analyzed the treatment and survival outcomes. Materials and methods: We reviewed the records of 19 patients with Barcelona Clinic Liver Cancer class B or C HCC who underwent treatment with Y90 RMS (for 21 sessions) while receiving full or reduced doses of sorafenib between January 2008 and May 2010. Therapy response was evaluated using Response Evaluation Criteria in Solid Tumors. We evaluated median overall survival (OS) and progression-free survival (PFS) as well as hepatic and extrahepatic disease PFS and incidence of adverse events. Results: The median patient age was 67 years, and portal or hepatic venous invasion was present in eight patients (42%). Ten patients received reduced doses of sorafenib. The median Y90 radiation activity delivered was 41.2 mCi. The partial response of Response Evaluation Criteria in Solid Tumors was observed in four patients (19%). The median hepatic disease PFS was 7.82 months, extrahepatic disease PFS was 8.94 months, OS was 19.52 months, and PFS was 6.63 months. Ninety days after treatment with Y90 RMS, five patients (26%) had grade II adverse events and four patients (21%) had grade III adverse events. Conclusion: OS and PFS outcomes were superior to those observed in prior studies evaluating sorafenib alone in patients with a similar disease status, warranting further study of this treatment combination. Keywords: yttrium-90, sorafenib, hepatocellular carcinoma