HCC Trial

Retrospective analysis of matched pairs with HCC treated with SIRT vs Sorafenib shows substantial OS benefit in SIRT treated patients. This is what SARAH trial is evaluating, although this cohort specifically had PVT thrown into the mix.



European Journal of Nuclear Medicine and Molecular Imaging
April 2016, Volume 43, Issue 4, pp 635-643
First online: 12 October 2015
Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis

• Julien Edeline
• , Laurence Crouzet
• , Boris Campillo-Gimenez
• , Yan Rolland
• , Marc Pracht
• ,Anne Guillygomarc’h
• , Karim Boudjema
• , Laurence Lenoir
• , Xavier Adhoute
• and 5 more

Abstract

Purpose

Tumoural portal vein thrombosis (PVT) is a major prognostic factor in hepatocellular carcinoma (HCC). The efficacy of sorafenib, the only treatment approved at an advanced stage, is limited. Based on previous data, selective internal radiation therapy (SIRT), or 90Y radioembolization, seems an interesting option. We aimed to compare both treatments in this population.
Methods

We retrospectively compared patients treated in two centres for HCC with tumoural PVT. We compared overall survival (OS) between patients treated with SIRT and patients treated with sorafenib. Analyses were performed before and after 1:1 matching with a propensity score for controlling indication bias, using a Cox proportional hazards model.
Results

A total of 151 patients were analysed, 34 patients treated with SIRT and 117 patients treated with sorafenib only. In the whole population, SIRT was associated with a higher median OS as compared with sorafenib: 18.8 vs 6.5 months (log-rank p < 0.001). There was an imbalance of baseline characteristics between patients treated by SIRT and sorafenib, which justified patient matching with use of a propensity score: 24 patients treated with SIRT could be matched with 24 patients treated with sorafenib. OS was estimated with a median of 26.2 vs 8.7 months in patients treated with SIRT vs sorafenib, respectively (log-rank p = 0.054). Before and after patient matching, the adjusted hazard ratio related to treatment by SIRT was estimated at 0.62 [95 % confidence interval (CI) 0.39–0.97] (p = 0.037) and 0.40 (95 % CI 0.19–0.82) (p = 0.013), respectively.
Conclusion

SIRT seems more effective than sorafenib in patients presenting with HCC and tumoural PVT. This hypothesis is being tested in prospective randomized trials.