Transarterial Radioembolization Safe and Effective in Liver-Dominant mCRC

Predictive markers, such as APRI and ALBI, can be helpful for clinical decision-making in patients with colorectal cancer liver metastases.

Transarterial radioembolization (TARE) is associated with an acceptable safety profile and has favorable survival outcomes among patients with liver-dominant metastatic colorectal cancer (mCRC), according to study results published in Clinical Colorectal Cancer.

Data for this analysis were sourced from the European-wide prospective, observational study CIRSE Registry for SIR-Spheres Therapy (CIRT) conducted at 27 sites between 2014 and 2017. Patients (N=237) with mCRC in the liver who received TARE with Yttrium-90 resin microspheres were evaluated for survival outcomes.

The study population included 62.0% men, patients had a median age of 63.0 (IQR, 55.0-71.0) years, they had been diagnosed 19.5 (IQR, 11.0-34.1) months previously, 33.3% had more than 5 tumor nodules, 64.1% had bilobar tumors, and 40.9% had extrahepatic metastases.

The patients received whole liver (48.1%), right lobe (38.0%), left lobe (11.0%), or segmental (3.0%) targeted treatment; 57.8% had treatment targeted at all tumors; and 93.7% had technical success. Most (88.6%) received 1 treatment.

Most patients (95.4%) received systemic therapy and nearly a third of patients (32.5%) received more than 3 lines of systemic therapies. Dosing was calculated using body surface area (BSA; 51.9%), modified BSA (30.0%), or the compartment model (17.4%). For TARE, 74.3% received TARE as a palliative treatment. Following TARE, 14.8% underwent additional locoregional procedures, and 36.7% received systemic therapy.

Our results identified new predictive markers for this patient population (INR, APRI and ALBI), and highlight the need for advanced dose methodology techniques to optimise the outcome of TARE in mCRC patients.

Stratified by aspartate transaminase to platelet ratio index (APRI), patients with APRI less than or equal to 0.40 had an overall survival of 13.8 months, and those with APRI over 0.40 had a survival of 7.7 months (P <.0001). Progression-free survival was 4.5 and 3.2 months (P =.034) and hepatic progression-free survival was 5.1 and 3.5 months (P =.0083) among the low and high APRI cohorts, respectively.

Stratified by dosing strategy, patients who had compartment model dosing were associated with increased survival (mean, 13.0 months) compared with those who received BSA or modified BSA dosing (mean, 9.2 months; P =.027).

Overall survival was associated with APRI over 0.40 compared with less than or equal to 0.40 (hazard ratio [HR], 2.28; P <.0001), international normalized ratio (INR) >over 1 compared with less than or equal to 1 (HR, 1.67; P =.0078), extra-hepatic disease prior to treatment (HR, 1.48; P =.0391), compartment model of dosing compared with BSA or modified BSA (HR, 0.45; P =.0120), and prior locoregional procedures (HR, 0.34; P =.0037). Progression-free survival was associated with APRI over 0.40 compared with less than or equal to 0.40 (HR, 1.42; P =.0416) and ablation (HR, 0.59; P =.0323). Hepatic progression-free survival was associated with albumin-bilirubin (ALBI) grade A3 compared with A1 (HR, 5.29; P =.0075), APRI over 0.40 compared with less than or equal to 0.40 (HR, 1.50; P =.0207), and 2 to 5 tumor nodules compared with one (HR, 0.42; P =.0148).

A total of 40.1% of patients reported 197 adverse events, 11.8% of whom had grade 3 or higher events. The most common grade 3 or higher events were abdominal pain, nausea, gastrointestinal ulceration, gastritis, and radiation cholecystitis.

The major limitation of this study was the observational design.

These data indicated that TARE was safe and effective for the treatment of liver-dominant mCRC.

“Our results identified new predictive markers for this patient population (INR, APRI and ALBI), and highlight the need for advanced dose methodology techniques to optimise the outcome of TARE in mCRC patients,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Schaefer N, Grözinger G, Pech M, et al. Prognostic factors for effectiveness outcomes after transarterial radioembolization in metastatic colorectal cancer: results from the multicentre observational study CIRT. Clin Colorectal Cancer. Published online September 19, 2022. doi:10.1016/j.clcc.2022.09.002