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Abstract 193: Comparison of Radioembolization versus Chemoembolization in a Propensity Matched Multi-Center Large Database Veteran Cohort for Early and Intermediate Stage Hepatocellular Carcinoma
Presentation: Sunday, June 12, 3 p.m.
Patients with hepatocellular carcinoma (HCC) in a large retrospective multicenter Veterans Affairs (VA) cohort who were initially treated with yttrium-90 (Y-90) radioembolization (TARE) underwent fewer subsequent therapies, when compared with chemoembolization (TACE) treatment.
Researchers at the Veterans Affairs Palo Alto Health Care System in California wanted to see which procedure performed better as a first-line treatment among HCC patients across the VA system.
“We didn’t entirely know what we were going to find,” said presenter Rajesh Shah, MD, director of interventional radiology and associate chief of radiology at the VA Palo Alto Health Care System. “I thought it was going to be a toss-up, similar to what was found in terms of overall survival in other studies.”
There had been a Phase 2 prospective study about 5 years ago comparing the two treatments that showed no difference in overall survival but that radioembolization had a longer time to progression, Dr. Shah said.
The researchers analyzed data across the entire VA system of 171 medical centers. They queried for patients with an HCC diagnosis since 2007 who had undergone either TACE or TARE as initial therapy. Patients who underwent surgery, ablation or transplant were excluded. Stage 4 cancer and unknown stages were excluded.
They did a propensity matching analysis between the two groups based on demographics, co-morbidities, stage and diagnosis year. After the matching, 768 patients (384 patients in each cohort) were included. There was no significant difference in median overall survival for TACE at 21.0 months vs. TARE at 20.5 months. However, TARE showed a significantly fewer number of subsequent intra-arterial therapies after initial treatment compared to TACE.
“That is important because of course bringing patients in for additional procedures not only adds costs to their health care but also really impacts the patients—there’s a lot of anxiety and side effects, so reducing the number of times they come in can help the patients but also really help the health care system overall,” Dr. Shah said.
These findings, and previous results from other Phase 2 studies, have affected the way Dr. Shah manages HCC patients at the Palo Alto center. “We’ve certainly been shifting more and more toward performing radioembolization earlier and as potentially first-line intra-arterial therapy for our liver cancer patients.”
Dr. Shah emphasized that their findings were across 171 medical centers, not one site. “Two key takeaways are that this study looked at a multicenter cohort and found that there was no difference in overall survival,” he said. “The second important aspect to this is that patients who undergo radioembolization have fewer subsequent intra-arterial therapies over their lifetime.”
Dr. Shah said the next step is for a research team to develop a Phase 3 multicenter randomized trial comparing the two treatments and their overall survival rates, time to progression and number of procedures.
