Safety of Combined Yttrium-90 Radioembolization and Immune Checkpoint Inhibitor Immunotherapy for Hepatocellular Carcinoma |
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| Affiliation: | 1. Division of Vascular Interventional Radiology, Department of Radiology, New York City, New York;2. New York University Langone Health, NYU School of Medicine, New York City, New York;3. Division of Abdominal Imaging, Department of Radiology, NYU Langone Health, NYU School of Medicine, New York City, New York;4. Perlmutter Cancer Center and Department of Surgery, NYU Langone Health, NYU School of Medicine, New York City, New York;5. Department of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York;6. Hepatology Section, Division of Gastroenterology, Department of Medicine, NYU Langone Health, NYU School of Medicine, New York City, New York;7. Transplant Institute, NYU Langone Health, NYU School of Medicine, New York City, New York;1. Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China;2. Changsha Central Hospital, Changsha, Hunan, China;3. Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China;4. Third Xiangya Hospital, Central South University, Changsha, Hunan, China;1. Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands;2. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands;3. Department of Urology, Ziekenhuisgroep Twente, Hengelo, The Netherlands;4. Strahlentherapie Bonn Rhein Sieg, Bonn-Bad Godesberg, Germany;5. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands;1. Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida;2. Department of Pathology, Mayo Clinic Florida, Jacksonville, Florida;3. Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida;4. Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida;1. Gastrointestinal Malignancies Section, Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, USA;2. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany;3. Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, USA;4. Thoracic and GI Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, USA;5. Translational Hepatology Unit, Liver Diseases Branch (LDB), National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) National Institutes of Health, USA;6. Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, USA;7. Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, USA;8. Center for Interventional Oncology, Radiology and Imaging Sciences and Center for Cancer Research, National Institutes of Health, USA;1. Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois;4. Section of Body Imaging, Department of Radiology, Northwestern University, Chicago, Illinois;2. Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois;6. Division of Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois;3. Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois;5. Department of Preventive Medicine, Northwestern University, Chicago, Illinois |
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| Abstract: | PurposeTo investigate the safety of yttrium-90 radioembolization in combination with checkpoint inhibitor immunotherapy for the treatment of hepatocellular carcinoma (HCC).Materials and MethodsThis single-center retrospective study included 26 consecutive patients with HCC who received checkpoint inhibitor immunotherapy within 90 days of radioembolization from April 2015 to May 2018. Patients had preserved liver function (Child-Pugh scores A–B7) and either advanced HCC due to macrovascular invasion or limited extrahepatic disease (21 patients) or aggressive intermediate stage HCC that resulted in earlier incorporation of systemic immunotherapy (5 patients). Clinical documentation, laboratory results, and imaging results at 1- and 3-month follow-up intervals were reviewed to assess treatment-related adverse events and treatment responses.ResultsThe median follow-up period after radioembolization was 7.8 months (95% confidence interval [CI], 5.6–11.8). There were no early (30-day) mortality or grades 3/4 hepatobiliary or immunotherapy-related toxicities. Delayed grades 3/4 hepatobiliary toxicities (1–3 months) occurred in 2 patients in the setting of HCC disease progression. One patient developed pneumonitis. The median overall survival from first immunotherapy was 17.2 months (95% CI, 10.9–23.4). The median overall survival from first radioembolization was 16.5 months (95% CI, 6.6–26.4). From first radioembolization, time to tumor progression was 5.7 months (95% CI, 4.2–7.2), and progression-free survival was 5.7 months (95% CI, 4.3–7.1).ConclusionsRadioembolization combined with checkpoint inhibitor immunotherapy in cases of HCC appears to be safe and causes limited treatment-related toxicity. Future prospective studies are needed to identify the optimal combination treatment protocols and evaluate the efficacy of combination therapy. |
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