Impact of combined selective internal radiation therapy and sorafenib on survival in advanced hepatocellular carcinoma

Abstract

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Comparison between Y90 Radioembolization Plus Sorafenib and Y90 Radioembolization alone in the Treatment of Hepatocellular Carcinoma: A Propensity Score Analysis

“…Similarly, the association of sorafenib and Y90RE did not result in a clear advantage in terms of progression-free survival being median PFS 6 vs. 7 months in Group 1 and 2 respectively (p = 0.992). These results confirm the findings of the aforementioned SORAMIC trial [19], thus strengthening the concept of the lack of benefit from combining the two treatments.…”

“…Despite the disappointing results of a large preliminary randomized controlled trial (RCT) [19], further studies are needed to properly evaluate the possible synergistic effects of the association of sorafenib and Y90RE. In particular, evidence on the comparison between Y90RE plus sorafenib versus Y90 alone is scarce, mainly provided only by a single RCT conducted in the pre-transplant setting, hence without the assessment of long-term survival outcomes [25,26].…”

“…The recent multicenter SORAMIC trial failed to find a significant superiority of the combination Y90RE plus sorafenib versus sorafenib alone although subgroup analyses indicated a survival benefit of combo therapy in patients without cirrhosis, cirrhosis of non-alcoholic aetiology, or patients ≤65 years old [19]; moreover, a higher rate of adverse events was observed with the combined approach [20]. On the other hand, comparative studies between Y90RE plus sorafenib and Y90RE alone are lacking.…”

Hepatocellular Carcinoma—How to Determine Therapeutic Options

“…Regarding combination therapy, the phase 2 prospective, randomized trial SORAMIC (98) compared Y-90 and sorafenib versus sorafenib alone for locally advanced HCC and showed similar median overall survival between groups (12.1 vs. 11.4 months, respectively). As the patient in case 2 has progressive disease with rising AFP despite two Y-90 treatments, transition to systemic therapy is most appropriate at this time.…”

Embolotherapy for Hepatic Oncology: Current Perspectives and Future Directions

“…80 Similarly, the SORAMIC trial failed to illustrate a survival benefit of SIRT-sorafenib combined therapy in BCLC B to C patients not eligible for TACE. 81 When comparing SIRT to sorafenib in patients with HCC and portal invasion, a study examining 151 patients with HCC and portal vein tumor thrombus found an overall median survival benefit in patients treated with SIRT compared with sorafenib, 26.2 versus 8.7 months, respectively (HR 0.40, 95% CI: 0.19-0.82, p ¼ 0.013). The difference in OS was more pronounced in patients with branch portal vein thrombosis (as opposed to MPV thrombosis), with a respective median OS of 25.3 months (95% CI: 13.8-36.8) versus 7.0 months (95% CI: 5.2-8.9) (p ¼ 0.001), than in cases of main PVT, with a respective median OS of 12.0 months (95% CI: 4.6-19.3) versus 6.5 months (95% CI: 4.8-8.3) (p ¼ 0.195).…”