Publicaciones científicas
Consensus statement on safety of combining transarterial radioembolization with 90yttrium microspheres with systemic anticancer agents for the treatment of liver malignancy
Andrew S Kennedy 1 , Daniel B Brown 2 , Marwan Fakih 3 , Rohan Jeyarajah 4 , Suzanne Jones 5 , David Liu 6 , David J Pinato 7 , Bruno Sangro 8 , Navesh K Sharma 9 , Daniel Y Sze 10 , Eric Van Cutsem 11 , Harpreet S Wasan 12
Purpose: To provide guidance, via multidisciplinary consensus statements, on the safety interactions between systemic anticancer agents (such as radiosensitizing chemotherapy, immunotherapy, targeted therapy and peptide receptor radionuclide therapy) and transarterial radioembolization (TARE) with yttrium-90 (90Y) labeled microspheres in the treatment of primary and metastatic liver malignancies.
Materials and methods: A literature search identified 59 references that informed 26 statements on the safety of 90Y TARE combined with systemic therapies. Modified Delphi method was used to develop consensus on statements through online anonymous surveys of the 12 panel members representing the fields of interventional radiology, medical oncology, surgical oncology, hepatology, and pharmacy, focusing on hepatocellular carcinoma (HCC), metastatic colorectal cancer (mCRC), neuroendocrine tumors, metastatic breast cancer and intrahepatic cholangiocarcinoma.
Results: High level evidence was limited. Level 1 data in patients with mCRC suggest that some radiosensitizing chemotherapies (e.g., oxaliplatin) require temporary dose reduction when used concomitantly with 90Y TARE and some targeted therapies (e.g., vascular endothelial growth factor inhibitors and anti-angiogenic tyrosine kinase inhibitors) should be avoided for at least 4 weeks before 90Y TARE. In patients with HCC, the feasibility of 90Y TARE and immunotherapy has been demonstrated with Level 4 evidence. Data are more limited for other primary and secondary liver malignancies, and consensus statements were driven by expert opinion (Level 5).
Conclusion: Given the absence of evidence-based guidelines on the safety of 90Y TARE in combination with systemic anticancer therapy, these consensus statements provide expert guidance on the potential risks when considering specific combinations.
CITA DEL ARTÍCULO J Vasc Interv Radiol. 2024 Jun 15:S1051-0443(24)00398-1. doi: 10.1016/j.jvir.2024.06.006
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