Yttrium-90 transarterial radioembolization (TARE) is a safe option for patients with hepatocellular carcinoma (HCC) and baseline hyperbilirubinemia, allowing for bridging or downstaging patients to liver transplant, a new retrospective study shows.
The role of selective TARE in the treatment of HCC is still expanding, moving from a palliative to a curative intent treatment, according to Muhamad Serhal, MD, a radiology and interventional oncology postdoc research fellow at Northwestern University in Chicago.
Historically, studies have shown that the risk of liver toxicity post-TARE increases with high baseline bilirubin, though baseline hyperbilirubinemia is often considered a contraindication for TARE. However, anecdotally, interventional radiologists have observed that the selective approach can be safe in patients with baseline hyperbilirubinemia, Dr. Serhal said. He will present the featured abstract “Safety of Selective Transarterial Radioembolization for Hepatocellular Carcinoma in Patients with Baseline Hyperbilirubinemia” during Monday’s Scientific Session 15, Liver Locoregional 1, from 3 to 4:30 p.m.
Dr. Serhal and fellow researchers conducted a retrospective chart review of HCC patients with baseline total bilirubin (TBili) >2 mg/dL treated with selective TARE between 2006 and 2021. Of the 129 patients, 68% were male, with a median age of 63.8.
The results showed that while median TBili at 1 and 3 months was significantly higher than baseline, there was no significant difference at 6 months. Of the 75 patients treated for bridge to transplant, 70% (52 patients) successfully underwent a liver transplant.
Toxicities were evaluated using CTCAE V5 criteria. Grade 3/4 TBili toxicities were seen in only one patient after 1 month, two patients after 3 months and seven patients after 6 months. Grade 3 albumin toxicity was present in four patients at baseline, five patients after 1 month, one patient after 3 months, and three patients after 6 months. There were no grade 4 albumin toxicities.
“Of course, a long-term prospective cohort with a larger study population, including a control group with normal pre-treatment bilirubin level, may be necessary to provide a better insight regarding safety and efficacy of Y-90 in patients with liver decompensation, but our study is a strong foundation for future studies,” Dr. Serhal said. For example, he said, “now based on our study, we can selectively treat a solitary HCC tumor in a patient with baseline hyperbilirubinemia. It is safe.”
