Journal of Hepatocellular Carcinoma (Sep 2021)

A Prospective Phase II Study of Safety and Efficacy of Sorafenib Followed by 90Y Glass Microspheres for Patients with Advanced or Metastatic Hepatocellular Carcinoma

  • Kaseb AO,
  • Kappadath SC,
  • Lee SS,
  • Raghav KP,
  • Mohamed YI,
  • Xiao L,
  • Morris JS,
  • Ohaji C,
  • Avritscher R,
  • Odisio BC,
  • Kuban J,
  • Abdelsalam ME,
  • Chasen B,
  • Elsayes KM,
  • Elbanan M,
  • Wolff RA,
  • Yao JC,
  • Mahvash A

Journal volume & issue
Vol. Volume 8
pp. 1129 – 1145

Abstract

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Ahmed Omar Kaseb,1 S Cheenu Kappadath,2 Sunyoung S Lee,1 Kanwal Pratap Raghav,1 Yehia I Mohamed,1 Lianchun Xiao,3 Jeffrey S Morris,4 Chimela Ohaji,1 Rony Avritscher,5 Bruno C Odisio,5 Joshua Kuban,5 Mohamed E Abdelsalam,5 Beth Chasen,6 Khaled M Elsayes,7 Mohamed Elbanan,7 Robert A Wolff,1 James C Yao,1 Armeen Mahvash2 1Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 3Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 4Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 5Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 6Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 7Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USACorrespondence: Ahmed Omar Kaseb Email [email protected]: The most common cause of death in advanced/metastatic hepatocellular carcinoma (HCC) is liver failure due to tumor progression. While retrospective studies and meta-analyses of systemic therapy combined with liver-directed therapy have been performed, prospective studies of safety/efficacy of antiangiogenesis followed by intra-arterial therapies are lacking. We tested our hypothesis that sorafenib followed by yttrium 90 glass microspheres (90Y GMs) is safe and that survival outcomes may improve by controlling hepatic tumors.Methods: We enrolled 38 Child–Pugh A patients with advanced/metastatic HCC. In sum, 34 received sorafenib, followed after 4 weeks by 90Y GMs. Analysis of safety and survival outcomes was performed to assess adverse events, median progression-free survival, and overall survival.Results: A total of 34 patients were evaluable: 14 (41.2%) with chronic hepatitis, nine (26.5%) with vascular invasion, and eleven (32.4%) with extrahepatic diseases. Safety analysis revealed that the combination therapy was well tolerated. Grade III–IV adverse events comprised fatigue (n=3), diarrhea (n=2), nausea (n=1), vomiting (n=2), hypertension (n=4), thrombocytopenia (n=1), hyperbilirubinemia (n=1), proteinuria (n=1), hyponatremia (n=1), and elevated alanine or aspartate aminotransferase (n=5). Median progression-free and overall survival were 10.4 months (95% CI 5.8– 14.4) and 13.2 months (95% CI 7.9– 18.9), respectively. Twelve patients (35.3%) achieved partial responses and 16 (47.0%) stable disease. Median duration of sorafenib was 20 (3– 90) weeks, and average dose was 622 (466– 800) mg daily. Dosimetry showed similar mean doses between planned and delivered calculations to normal liver and tumor:normal liver uptake ratio, with no significant correlation with adverse events at 3 and 6 months post-90Y treatment.Conclusion: This is the first prospective study to evaluate sorafenib followed by 90Y in patients with advanced HCC. The study validated our hypothesis of safety with encouraging efficacy signals of the sequencing treatment, and provides proof of concept for future combination modalities for patients with advanced or metastatic HCC.Clinical Trial Registration Number: NCT01900002.Keywords: HCC, sorafenib, yttrium 90, BCLC, hepatocellular carcinoma

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