Safety and Effectiveness of Yttrium-90 Radioembolization around the Time of Immune Checkpoint Inhibitors for Unresectable Hepatic Metastases |
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Institution: | 1. Department of Interventional Oncology/Radiology, Memorial Sloan Kettering Cancer Center, New York, NY;2. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands;3. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands;4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;5. Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY;6. Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY;1. Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Strasse 44, Magdeburg 39120, Germany;3. Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany;1. Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;1. Division of Vascular and Interventional Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC 20007-2113;2. Department of Radiology, Inland Imaging, Providence Sacred Heart Medical Center, Spokane, Washington;3. Division of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, Maryland |
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Abstract: | PurposeTo assess the safety and effectiveness of yttrium-90 radioembolization and checkpoint inhibitor immunotherapy within a short interval for the treatment of unresectable hepatic metastases.Materials and MethodsThis single-institution retrospective study included 22 patients (12 men; median age, 65 y ± 11) with unresectable hepatic metastases and preserved functional status (Eastern Cooperative Oncology Group performance status 0/1) who received immunotherapy and radioembolization within a 15-month period (median, 63.5 d; interquartile range, 19.7–178.2 d) from February 2013 to March 2018. Primary malignancies were uveal melanoma (12 of 22; 54.5%), soft tissue sarcoma (3; 13.6%), cutaneous melanoma (3; 14%), and others (4; 18.2%). Studies were reviewed to March 2019 to assess Common Terminology Criteria for Adverse Events grade 3/4 toxicities, disease progression, and death.ResultsThere were no grade 4 toxicities within 6 mo of radioembolization. Grade 3 hepatobiliary toxicities occurred in 3 patients (13.6%) within 6 months, 2 from rapid disease progression and 1 from a biliary stricture. Two patients (9.1%) experienced clinical toxicities, including grade 4 colitis at 6 months and hepatic abscess at 3 months. Median overall survival (OS) from first radioembolization was 20 mo (95% confidence interval CI], 12.5–27.5 mo), and median OS from first immunotherapy was 23 months (95% CI, 15.9–30.1 mo). Within the uveal melanoma subgroup, the median OS from first radioembolization was 17.0 months (95% CI, 14.2–19.8 mo). Median time to progression was 7.8 months (95% CI, 3.3–12.2 mo), and median progression-free survival was 7.8 mo (95% CI, 3.1–12.4 mo).ConclusionsCheckpoint immunotherapy around the time of radioembolization is safe, with a low incidence of toxicity independent of primary malignancy. |
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