SIRT vs sorafenib in HCC with portal vein thrombosis

Apologies if posted previously, but worth a look. 4/34 patients in the SIRT arm were converted to surgery, all of these had survival at least 25 months. Median OS of 18.8 months in the SIRT group in this retrospective study, raises the possibility that insufficient events means the SIRT group has not achieved 50% median survival yet. Other possibility is that the French bods running the trial haven't had enough wine and cheese events to get around to analysing the data.


Eur J Nucl Med Mol Imaging. 2016 Apr;43(4):635-43. doi: 10.1007/s00259-015-3210-7. Epub 2015 Oct 12.

Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis.

Edeline J1,2, Crouzet L3, Campillo-Gimenez B4, Rolland Y5, Pracht M3, Guillygomarc'h A6, Boudjema K7, Lenoir L8, Adhoute X9, Rohou T5, Boucher E3, Clément B10, Blanc JF11, Garin E10,8.
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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 (90)Y 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.