Outcome of locally advanced hepatocellular carcinoma treated with selective internal radiation therapy compared to sorafenib: a multicenter experience in the Philippines

Abstract

Significance: Sorafenib is the recommended first-line therapy for patients with advanced hepatocellular carcinoma (HCC). There is limited Philippine data comparing the benefit of selective internal radiation therapy with yttrium-90 resin microspheres to sorafenib in patients with locally advanced HCC. Methodology: This is a post hoc analysis involving Filipino patients included in the SIRveNIB trial. Primary end point was overall survival. Analysis of efficacy of treatment was performed in the intention-to-treat population. Patients who were >18 years old diagnosed with locally advanced HCC without extrahepatic disease, with or without portal vein thrombosis, and were not amenable to curative treatment options, were randomly assigned 1:1 and received assigned treatment. Survival rates up to 18 months were estimated and compared between the two groups.

Results: A total of 57 patients were randomly assigned (SIRT 29; sorafenib 28). Males comprised 48%, mean age of 56. Chronic hepatitis B infection was present in 54.4% of patients. Most were Child A (91.2%), 58% had BCLC B, and 35% had portal vein thrombosis. Disease control rate was better with SIRT [86% (95% C.I., 64%, 97%) versus 32% (95% C.I., 14.9%, 53.5%)]. Median OS was 8.31 months with SIRT and 5.75 months with sorafenib (HR 0.75; 95% CI, 0.41 to 1.36; p = 0.34). Fewer patients receiving SIRT experienced treatment-related adverse events [SIRT, 9/21 (42.9%) versus sorafenib, 21/25 (84%)] or treatment-related serious adverse events [SIRT, 2/21 (9.5%)] versus sorafenib, 14/25 (56%)].

Conclusion: Difference in overall survival among locally advanced hepatocellular carcinoma treated with SIRT compared to sorafenib is not significant. Fewer adverse events were noted in patients treated with SIRT.