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Yttrium-90 Microspheres for Intermediate- or Advanced-Stage Hepatocellular Carcinoma #MMPMID34191460
Young C; Subramonian A; Argaez C
Yttrium-90 Microspheres for Intermediate- or Advanced-Stage Hepatocellular Carcinoma-/-CADTH Health Technology Review 2021[Mar]; ä (ä): ä PMID34191460show ga
Primary liver cancer has the sixth-highest incidence of all cancers and is the fourth-largest cause of cancer-related mortality worldwide. Estimates for 2020 suggested that 3,100 Canadians would be diagnosed with primary liver cancer and that 1,450 Canadians would die from it. In particular, data from the Long Form Census in Canada suggest that members of First Nations have disproportionately high rates of primary liver cancer, emphasizing the importance of attention to this condition in Canadian settings. While the prevalence and cancer-related mortality of primary liver cancer are higher in males (accounting for 10.2% of all cancer-related deaths in males worldwide), primary liver cancer is still a significant cause of disease burden in females (5.6% of all cancer-related deaths in females worldwide). The most common type of primary liver cancer is hepatocellular carcinoma, which accounts for approximately 80% to 85% of primary liver cancers.(,) Risk factors for the development of hepatocellular carcinoma include chronic alcohol consumption, viral hepatitis (e.g., hepatitis B, hepatitis C), cirrhosis of any etiology, and non-alcoholic fatty liver disease.(,) Treatment options for hepatocellular carcinoma consist of surgical (e.g., resection and liver transplantation) and non-surgical techniques, including locoregional therapies (e.g., percutaneous ethanol injection, radiofrequency or microwave ablation, transarterial chemoembolization [TACE] or transarterial radioembolization [TARE]) and systemic therapies (e.g., sorafenib, lenvatinib, and atezolizumab-bevacizumab). The selection of appropriate treatment is typically informed by tumour stage, liver function, and patient performance status, all of which are important factors that may influence treatment outcomes,(,) and selection is best done by a multi-disciplinary team. Surgical resection is the treatment of choice for patients with single nodules, no underlying cirrhosis, and good liver function. While patients who undergo surgical resection have a reasonably good prognosis (a 5-year survival rate of approximately 70%), a majority of patients with hepatocellular carcinoma are diagnosed with advanced disease when patients become symptomatic and have some degree of liver impairment. In many of these cases, surgical resection may no longer be appropriate. As a form of radiation therapy for patients with advanced or inoperable hepatocellular carcinoma, TARE (also known as selective internal radiation therapy [SIRT]) has been used to downstage patients before surgery or to bridge patients to liver transplantation. As part of this procedure microspheres loaded with a radioactive isotope, most commonly yttirium-90 ((90)Y), are delivered into the hepatic artery via a catheter inserted into the femoral artery. The therapy delivers a high dose of targeted radiation directly to the cancer cells, while also blocking the supply of blood to the tumour. Conventional transarterial chemoembolization (cTACE) is administered using a procedure similar to TARE; however, instead of radiation the patient is given regional chemotherapy (usually doxorubicin or cisplatin) before an embolic agent. TACE can also be performed using drug-eluting beads that combine the chemotherapeutic agent with the embolic agent (i.e., drug-eluting bead transarterial chemoembolization [DEB-TACE]). The objective of this report is to evaluate the evidence regarding the clinical effectiveness and cost-effectiveness of TARE using (90)Y microspheres to support decisions involving the use of this therapy to treat patients with intermediate- or advanced-stage hepatocellular carcinoma. This report complements previous CADTH evaluations of the evidence regarding the use of (90)Y microspheres for the treatment of other cancers, including uveal melanoma liver metastases, liver metastases from colorectal cancer, and primary or secondary liver cancer.
Yttrium-90+Microspheres+for+Intermediate-+or+Advanced-Stage+Hepatocellular++Carcinoma-/-CADTH+Health+Technology+Review 2021 ; ä (ä): ä
