Emerging role of radioembolization for hepatocellular carcinoma

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Published: 8 May 2019
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Prof Riad Salem - Northwestern University, Chicago, USA

Prof Riad Salem speaks to ecancer at the 2019 International Gastrointestinal, Liver and Uro-Oncology Conference (IGILUC) in Cairo about the use of radioembolization for patients with hepatocellular carcinoma.

Prof Salem discusses the role of this emerging technique at multiple stages of the disease - including early, intermediate and advanced disease.

He also highlights how the use of this treatment could be incorporated into new paradigms - including the acceleration of yttrium-90, which would minimise the need for multiple procedures. Advances in this area also include the introduction of 'same day radioembolization'.

Prof Salem also mentions the exciting possibility of combining yttrium-90 with systemic therapies including immunotherapy - which are ideas that will require additional research in the future.

 

At this meeting in Cairo I’ll be talking about the emerging role of radioembolization for hepatocellular carcinoma.  This has been something that we have been working on for at least a decade now. The idea with every new treatment is to identify what patient population might benefit. After about, like I said, a decade, fifteen years, of work we’ve realised that Y-90 radioembolization can be applied at multiple stages of hepatocellular carcinoma. In patients with early disease you can think about curative application in small lesions that potentially are not resectable or ablatable and we have survivals of seven years median. In intermediate disease in patients where we might consider chemoembolization or something else we have median survival of 25 months treated with radioembolization and this is, to me, quite competitive to other standards of care therapy. And, very exciting, is in the patients with advanced disease, portal vein thrombosis, we have median survivals ranging from 14-16 months depending on the patient population. The better you select your patient, the better the outcome. In fact, the group from Milan has published 32 months’ median survival in patients with portal vein thrombosis if properly selected.

So what we think is radioembolization can be applied in multiple settings. Very exciting in terms of new treatments now and new paradigms is to think about accelerating the process of Y-90, minimising the need of multiple treatments for patients and multiple procedures. So one of the advancements for us has been the same day radioembolization where you can do the entire process – the mapping angiogram, the embolization and the treatment – in one day. In fact, we’ve even gone to discussing the one hour Y-90 where patients come in, we treat them with a Y-90, do not perform any embolization or any lung shunt study, because if you have very small tumours that test is not necessary. So we’ve gone from a procedure that was very complex a decade ago to something that can be streamlined to an hour or less in properly selected patients.

I would say that in terms of research and excitement the most exciting stuff is to think about combining Y-90 with systemic therapies. There are now many systemic agents available – lenvatinib and cabozantinib and regorafenib and all types of other agents. But interestingly the immunotherapies are also very interesting. I think combining Y-90 with nivolumab or pembrolizumab or durvalumab or all these other things are things that we need to look at because the idea is advanced patients may benefit from multiple types of treatment and combining Y-90 with the immunotherapies is something that’s very exciting.

So, overall, a lot of excitement. I’m happy to be here in Cairo to discuss this with my colleagues at IGILUC and hope I get to come back next year.